Rethinking power and targets

Transforming health and social care requires taking bold new steps. We look at a recent example that can provide insight into what works.

The transformation of health and social care requires people with lived experience to be at the heart of it, however this requires person centred approaches that utilise cross sectoral support. As part of its ongoing work the Health and Social Care Academy (the Academy) is invested in exploring and promoting ways that challenging target culture and encouraging the sharing of power can result in more transformational change in health and social care. Looking at a recent success story in the UK provides an excellent demonstration of the radical positive changes that this can result in, both for those providing and receiving care.

The NHS is currently under a great deal of pressure as a result of being short on beds and staff at a time where a growing number of people are being admitted to hospitals. This has led to discharge dates for people being considered a key metric of success, an emphasis that sometimes ignores the voices of patients and fails to take a more rounded perspective on what should be considered a success.

This was highlighted in a report (this link will take you away from our website) from the British Red Cross, that noted that premature discharges sometimes resulted in rapid readmissions from patients who were either unready to be discharged or who lacked the necessary support at home to prevent further complications. The decision to discharge a person at times can be made without consulting a broad range of stakeholders to determine whether this is the correct decision or whether there are sufficient plans for people to be supported and in control of their health once they have returned home.

There are, however, examples of the value of taking the courageous step to challenge the status quo and to pioneer new perspectives and approaches. A successful initiative has recently been launched in Hartlepool, Home Safe Sooner (this link will take you away from our website), that ensures that a broad range of people are involved with decisions around discharge and the support that follows this up. Patients and doctors work closely with their hospital’s physiotherapy and occupational therapy services as well local voluntary organisations to ensure that decisions are being made in an informed manner.

This ceding of power to a broad range of invested parties and the shift in focus to measuring success as being more than a swift discharge rate have already yielded impressive results, with an 18% drop in rapid hospital readmissions, an award for healthcare innovation and, most importantly, improved experiences and outcomes from the people who are returning home. Speaking to the Guardian (this link will take you away from our website) a staff nurse at one of the hospitals trialling this approach noted that “You no longer have tunnel vision where you are focused on your area alone. It has changed how we work for the better.”

By looking beyond simple metrics and taking a more holistic view of the welfare of people there has been a strong step towards aiding long term wellbeing developments.  By encouraging cross sectoral cooperation that includes the voices of people and their communities there has been a more complete perspective available when making decisions, leading to increased empowerment and improved outcomes.

It is vital that we continue to challenge existing systems and assumptions within health and social care and explore transformational alternatives. The Academy, though it’s Five Provocations For The Future of Health and Social Care, is doing that. If you have any thoughts on ways that the Academy can help explore transformative new ideas for Scottish health and social care then please contact the team at academy@alliance-scotland.org.uk.

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