Can Do Health & Care - NHS Uncomfortable Truths Report

28 | ICS System Learning: Uncomfortable Truths We still have a long way to go on personalising services, which is incredibly difficult particularly with a finite resource. What brought that home to me was being a local councillor in Tottenham, an incredibly vibrant and diverse area of London with brilliant community spirit, but also incredible challenges. At my regular constituency surgeries people would come with a presenting need, but behind that was a multiplicity of other factors such as domestic violence, poor accommodation, education and jobs; and as a councillor I was trying to navigate the complexity of the public sector to get the right help for them. I do not think in healthcare we have really recognised the importance of local councillors as our eyes and ears on the ground and our ambassadors. “We still don’t do enough of understanding each other’s worlds, even in this room. And because we are all madly busy and there is so much pressure upon us, we often neglect relationships and putting ourselves in each other’s shoes around how we should operate differently.” We can put frameworks and systems in place, but we have still got to come back to relationships and seeing beyond people’s presenting needs. Anthony: In terms of learning from experiences, we often try one thing after another with no real memory of what has already happened. I think we try but we are far less successful than some jurisdictions, for example Scandinavia. However there are pockets of integration in the UK that are some of the best in the world. One example is psychiatrists whose approach is ‘let’s do what we can’ rather than multi-agency referral forms, eligibility criteria and thresholds, and restricted access, which leads people to blaming the system. They are taking individual responsibility, drawing on their values, and involving families. They are not under any greater pressure than those who have erected barriers, it actually takes a lot of effort to maintain barriers. The approach that ‘a problem for one is a problem for all’, good triage and joint working enables them to get a lot more basic care to a lot more people. Zoe: My overriding uncomfortable truth is that we can define the problems that we want to solve to achieve and the outcomes that we want to see; we know that prevention is always the best approach; we strive to connect with and walk alongside our patients, carers and staff with co-production at the heart of everything we do; we know that treating the whole person, locally, through wrap-around care is the only way forward; we believe in ‘one front door’; and we want to tear down institutional barriers; but crucially we have all known this for a generation. Too often these issues which require interrelationships across organisations, involving understanding different people with different perspectives and backgrounds we put in a ‘too difficult box’. “We need to get hold of the ‘too difficult box’ and pull all the issues out of it, burn the box and start again with renewed vigour.” Godwin: Part of the process of learning is listening. When people talk about their lived experience, believe them. If a patient says they are in pain, believe them. More often than not, there is an excuse for poor service to marginalised communities, ‘you are imagining this’ or ‘that’s not how it is happening’. We speak to community leaders on a daily basis and their community members are telling us that’s how it is.