A look back at Transforming Care: too damn complex in practice
The official line on government policy to enable more people to live in the community is that it has been successful. Some people working in the system may disagree, says Steph Thompson
A dog-eared copy of the Harvard Business Review is glaring at me. Inside, a feature on tackling bureaucracy concludes: ‘These times call for a new era of accountability, but not the end to innovation … let us educate ourselves and our people so that the focus can be on ingenuity, not conformity.’
With 1.5 million workers, the NHS is possibly the world’s largest non-military bureaucracy. How on earth does one begin to grapple with the size of the NHS and achieve accountability alongside innovation and ingenuity? How can we connect the NHS to social care in an ‘integrated system’ (again)? Who has the power and ability to effect systemic change?
“One takeaway from Transforming Care is the unintended
consequences of oversimplifying complex issues”
I choose to be optimistic. To see a learning NHS. To believe that the values and goodwill of the vast majority of its workforce and, yes, of its political classes can nudge our NHS behemoth in the right direction. But …
With only months to go, the official line on Transforming Care is that it has been successful. I think some people working within the system may disagree. The numbers can be ‘interesting’.
For example, the pressure to meet discharge targets has meant quick fix solutions, sometimes involving beds in smaller units rather than the flexible support in flexible housing that was the initial vision.
Of course, low-hanging fruit gets picked first. It turns out that, for a minority of people living in NHS beds for a long time, moving out was relatively easy. The remaining majority, however, are more challenging to support to move back into their community, so progress against targets is harder.
Targets are essential but one takeaway from Transforming Care has to be the unintended consequences of oversimplifying complex issues. I’m sure the Home Office, in the wake of Windrush, feels the same.
There are parts of the country where the people leading Transforming Care have really given it a go. What worries me is that this is usually down to passionate individuals, navigating their way through a complicated system to commission support for complex individuals in hospital beds.
It worries me because, once again, great commissioning and delivery of packages of support for people with learning disabilities has taken place outside the mainstream.
Yes, the ‘system’ has created downward pressure but tenacity and respectful relationships between people linked to those in hospital who should have a different life is what has made the difference.
It worries me because the people leading Transforming Care are consistently stymied by resource flows between NHS England, clinical commissioning groups and local authorities. It worries me because we still have not sorted out what good community outcomes mean. It worries me because the demands on NHS leaders to ‘sort out the system’ can crush positive joint working, improvements and corporate memory of what works.
Last night, I dreamed it was all ok. I dreamed that the new accountable care systems rode to the rescue of our system, unblocked all blockages and made change happen. I dreamed that all those people busy trying to manage the complexity out of convoluted systems were suddenly able to focus on people with complicated support needs. I dreamed well-written plans actually became real.
I woke up disappointed. As someone long in the tooth in NHS and local government, I have a nagging sense of deja vu. I increasingly believe that the NHS must now follow the Bank of England on the path to independence. Because, politically, it’s all too damn complicated.
Steph Thompson is a director of Dimensions (www.dimensions-uk.org) and managing director of Waymarks (waymarks.org.uk)
