Day Seven In The House

Written by: Cath Cooney, Director of Development and Improvement, the ALLIANCE

Published: 17/05/2016

Cath considers her new role, the challenges facing health and social care and how House of Care can help support change and improvement.

Our latest viewpoint comes from the ALLIANCE’s new House of Care Programme Manager, Cath Cooney, and considers her new role, the challenges facing health and social care and how the House of Care model can help support change and improvement.

Coming in to a new post it’s not always the norm to be given the chance to have your say about how useful you believe your new workstream could be to the wider system. But that’s the ALLIANCE for you – inclusive, giving voice and encouraging debate for action.

So, my question seven days into my new role: Is the House of Care (HoC) model a tool that has the potential to support transformational change across the Scottish health and social care landscape?

If yes, then how might it support the Boards and Partnerships in a real and practical way?  We face many challenges in implementing a change programme at sufficient scale and depth within the current context but there are three overarching themes:

People and Relationships – Harder and faster won’t do it. In my experience, relationships are always at the heart of successfully implementing change – remembering the humanity and core values in effective care and support planning and having conversations that change lives. There is optimism with the Chief Medical Officer’s Realistic Medicine report and the Deep End and National Link Worker programmes. Importantly, the Collaborative Care and Support Planning, House of Care approach is key to the strategic policy of the Royal College of General Practitioners (Scotland) and is contained within the Blueprint for Scottish General Practice. As Professor Graham Watt said at a recent Health Literacy conference: “relationships are the silver bullet, not drugs, in primary care and general practice”.

Busy Landscape – It’s important to think about the nature of the ‘message’ and how well it is understood. Health literacy is key here, both for people with long term conditions and their carers using services – how can they be supported to navigate and influence their care and support? For staff, understanding how to move towards a more person centred care practice approach needs time to explore what that means, and a willingness to cede power, and that can be challenging. Changes in practice and culture, as recommended in the Health Literacy Action Plan: Making it Easy, are required.

Culture Audit Scotland has highlighted the need for strong national leadership and clear planning if health and social care services are to adapt to new pressures. Fostering and creating the conditions where courageous leadership can flourish is key and the third sector has a role to play in this. I’m reminded of discussion from a recent ALLIANCE dialogue event on Scotland’s new National Clinical Strategy: “There is a strong appetite for a third sector leadership role in designing…a blueprint and we must make sure we don’t default to a position where the third sector is seen as a supply chain rather than rightly as a catalyst of innovation and integral to the design of strategy/services”.

What the House of Care (HoC) Brings

From what I’ve seen so far, a HoC approach provides a lens to see where things are going well and the nature of existing assets, and where change and improvement is needed. This week a practitioner at one of the Lanarkshire HoC early adopter sites described it as a Russian doll. Whatever level it is applied at, it´s clear that the House can only stand if all the structures are strong and in place.

As a strategic partner of the Scottish Government, and with close working relationships across the statutory and third sectors, the ALLIANCE is in a strong and unique position in having experience in both of the walls, the foundations, and the roof of the House of Care, as well as the central conversation. Work has already begun with five early adopter sites and we hope to support these sites to complete this journey as well as support new sites to understand and adopt the model.

My aim is for the national House of Care Programme in Scotland to continue to support health and social care to flourish by focussing our efforts on:

  • Building the Scottish capacity for person centred care through care and support planning conversations that include, and are informed by, the voices of people with lived experience
  • Capturing and sharing the stories of this working in ways that can be understood by a wide audience
  • Amplifying and connecting the streams of good practice ref ALISS and National Links Worker projects.

So, that’s where my thoughts are on day seven in the house…let’s see how we go.

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