When Albert Einstein was asked his New Year’s resolution he, now famously, said “Learn from Yesterday, Live for Today, Hope for Tomorrow”.
It’s a new year and, as we move from the last few weeks of the 4 year ‘Putting You First’ (PYF) change programme towards the integration of health and social care, it feels like a good time to ‘learn from yesterday’.
It is nigh on impossible to pick up any national strategy, policy document or guidance on health and social care without coming across the phrase transforming health and social care services.
Here in Dumfries and Galloway, PYF has set us off on this journey of transformation; four years of developing
- New ways of working
- New thinking and
- New partnerships between Communities, Carers, the Third and Independent Sectors, Dumfries and Galloway Council and NHS Dumfries and Galloway.
There are good past examples of where we have successfully delivered transformational level change in Dumfries and Galloway, however, the scale at which transformational change is required in health and social care today is unprecedented. It is complex, requires a significant level of commitment and resource to achieve and takes time to deliver.
Impacts of transformational changes are often long term and non-linear. This means it is challenging to evaluate and demonstrate impact. However, an increasing focus on demonstrating ‘outcomes’ in the future rather than inputs and outputs and the achievement of short term goals will help to address this.
PYF worked around a key principle of broad partnership working enabling a truly ‘whole systems approach’ between health, social care, housing, the independent sector, the third sector and communities.
“The experience of partners working together across all sectors through PYF has created a real momentum. Providers involved in meetings and tests of change have experienced a real difference for them personally – they say they are better informed, feel more engaged and, best of all, have become to feel more like real partners, rather than just contractors. Where individuals from different sectors have worked closely together the change has been even more dramatic – attitudes have changed and partners have realised that they ARE BOTH working to create better outcomes for older people.” (Sue Newberry Scottish Care Associate)
Acknowledging and accepting the different cultures that exist within each sector is important. It helps develop our understanding of each other and respect each other’s values and beliefs. This cultural diversity can bring new and different perspectives to thinking providing us with a more multi-dimensional overview.
“There is no doubt that the work in the Annan Pathfinder project has improved our understanding of the challenges we face as a team and helped us to use the different skills and approaches to better serve the individual we are caring for. This change in attitude and culture can only be built from the groups of individuals in these teams working more closely together to realise the assets we have within each and every community. These more integrated teams are the key to a different, more person centred approach to care which emphasises the responsibilities of the individual and the community.” (Dr Neil Kelly)
Whilst the continued support of the PYF Programme Board, Locality Groups, Work Streams and Enablers has been vital to the success of this change programme, what has been achieved has been as a result of everyone acknowledging and embracing their own unique leadership role within their particular areas of expertise and interest.
“We need to encourage ideas from all levels of the organisation and provide people with the opportunities, support and “permission” to take their ideas forward. Recognizing the unique contribution that every person plays in delivering improvements is key to success, and critical to the continued development of services, teams and individuals.” (Linda McKechnie, Service Development Manager)
Working Co-productively with Communities
New ways of working together with communities was a key element of successfully delivering change at community level.
“Encouraging people and communities to take ownership of services and assessing their own health and care needs empowers people. It supports people to understand the processes involved in planning and the constraints and demands placed (on) services. I think people like to do rather than be done to. Community integration, participation and planning as well as inspiring, collective and future thinking leadership are key for any future and successful integration in my eyes” (Suzanne McGarva, Pathfinder Evaluation Programme Lead)
All of the tests of change that have been undertaken have quite naturally fallen under one or the other of these four themes.
- Developing Communities/Community Resilience
- Optimising Technology as an Enabler
- Integrated Ways of Working
- Preventative and Anticipatory (Proactive) Approaches
“As we move towards health and social care integration, it is important that we consider the 4 themes and the tests within each of them. The learning from these provide a helpful source of information that could contribute to the development of the Health and Social Care Locality Plans with a particular focus on supporting the delivery of the 9 national integration outcomes.” (Mark Sindall, PYF Programme Manager)
What other people had to say about some of the work developing under these 4 themes
Developing Communities/Community Resilience
“Time bank has given individuals a chance in their own communities, contributing to new skills, enhancing their social networks and community engagement and therefore having a positive feeling of self-worth.” (Action for Children)
“Time Banking makes me feel I’m still able to offer something even though I’m in my 70’s” (Time banker)
“Makes an awful difference having the (Hard of Hearing) service, I don’t know what I would do. I don’t drive; I just wouldn’t wear my hearing aids”. (Service User)
“Fantastic piece of work (Single Point of Contact Initiative – Falls Pathway) with real benefits for patient’s going forward.” (Scottish Ambulance Service)
Optimising Technology as an Enabler
“Feel more confident. Was having trouble sleeping before (telecare) installation but happy there’s a backup in place and it is a lot more comfortable at home now” (Service User)
Integrated Ways of Working
“I have certainly made use of the ideas team on the end of the phone when I have not
been sure of how to manage residents’ behaviour. I have personally found that very useful to get support when I’ve needed it” (Care Home staff member)
“If we did not get the timely and co-ordinated support from the health and social care hub, we would really have struggled to manage at home.” (Service User)
Preventative and Anticipatory (Proactive) Approaches
“It’s good to know that there are people looking out for you and your health as people like myself are sometimes too busy looking after everyone else and tend to forget about ourselves.” (Carer)
“‘I was suffering with anxiety and unable to concentrate. I was desperate and unable to cope….my life is better, much better now” (Carer)
“I am able to live in my own home which means the world to me”
“Through this discussion (Forward Looking Care Planning) my family is now aware of what I do and don’t want to happen to me”
“Once the nurse had visited, adaptations happened very quickly and we had been waiting months for this” (Forward Looking Care)
Hope for Tomorrow
Are we facing complex and challenging times ahead? – Certainly, but there is hope for tomorrow. As well as all of the learning from PYF, there are many other opportunities on the horizon that we can capitalise on to support us to achieve the level of transformation of health and social care in Dumfries and Galloway that will deliver long term sustainability.
“Innovations in technology and treatments offer opportunities to change the way in which care is delivered.” (Royal College of GPs Report – November 2014)
The integration of health and social care is another opportunity for us to further develop new models of holistic, person-centred, seamless, team-based care and support for people with chronic, multi-morbid conditions; focussed on improving outcomes and working to support every person in Dumfries and Galloway to achieve what matters to them.
To see some of the PYF work in action, please click on the link below
Vicky Freeman is Acting Head of Strategic Planning at NHS Dumfries and Galloway