“The Emperor’s New Clothes”

05 March 2018

Professor Martin Green OBE has had an extensive career in NGO development, both in the UK and internationally, and is Chief Executive of Care England, the largest representative body for independent social care services in the UK. He will be speaking at Living and Dying Well with Frailty event on 6 March. Follow the conference on the day via #bgsconf

We have now got a Department of Health and Social Care, what a difference that is going to make (I said sarcastically). With increasing regularity, the Government seems to think that messing about with the headed paper is a route to change. How much evidence do they need that changing titles and rejigging the logos is not going to deliver the transformational change that is required in order to deliver the route map to integrated services. If we had spent one tenth of the money we have spent on new titles, new structures and new logos on culture change, we would be in a far better position than we find ourselves today and the integrated services that citizens are crying out for might be a more attainable goal.

It is not only governments who have deluded themselves into believing that every problem can be solved by changing the packaging rather than looking at what's inside.

We used to see it time and again in business, where problems with reputation or public scandals would be responded to by changing the image, rather than changing the substance. Windscale became Sellafield, British Steel became Corus, Marathon became Snickers and millions of pounds were spent in pursuit of the design rather than the delivery of the service.

In my time in health social care we have had Health Authorities, PCT’s, CCGs, Health and Wellbeing Boards, and STPs, to name but a few. We have played with joint appointments across health and social care, we have had trailblazers and vanguards and yet despite it all we have not got an integrated health and social care system that works for our citizens.

Part of the problem is that when people talk about integration, they are obsessed with the organisations rather than the outcome to the citizens. Real integration is about how you experience the service and the background architecture should be invisible to the service user. Instead of starting with an obsession about whether or not structures are integrated, there should be one success measure for an integrated service and that is the experience of the citizen.

I am not interested in whether or not it is a health or social care service, what I am interested in, is the outcome it delivers to me.

I think this endless obsession with organisations is detracting from the real issue of how we deliver a high-quality support, which enables people to live well. What citizens want is not a string of services, what they want is the outcome.

Integrated systems which are made up of a multiplicity of organisations are possible. If you take a flight from one country to another there will be several organisations and international jurisdictions involved but you won't be aware of any of that because what you will experience is a flight from A to B and none of the interface between the organisations will be visible.

I am sure that even as I write this, there are designers getting ready to produce a new logo for the fully integrated Department of Health and Social Care. I suggest that instead of looking to their branding they look to their customer and start thinking how they will deliver something that changes people's lives, rather than something whose success is judged by a design award, rather than a patient experience.

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