Rescuing the Sacred Cow by @maidenturret

Re-Humanising Health and Social Care

The poor sacred cow that is the NHS is currently being kicked about something rotten, as political parties bombard us with promises and commitments to address the challenges our beloved institution faces. Thank goodness it will all be over by the end of this week! When you cut through the rhetoric, a lot of what you read totally misses the point for me. Unless we reframe the way we define health and wellbeing, any serious investment (against a background of rising demand) in the NHS will be just be propping up a broken out of date system.

The founders of the NHS saw healthcare as one element of wider welfare reforms aimed at reducing poverty, improving education, housing and employment. There is a certain irony that the health budget has been protected in recent years (although it doesn’t feel like it for folks working in health! – given health inflation) at the expense of cuts in services that will aggravate ill health.

Decreasing resilience

We have seen fabulous improvements in quality across NHS Scotland over the last 10 years, including world leading improvements in patient safety. However, attempts to improve or tweak existing models of care delivery, has failed to cope with rising demand and deliver sustainability. The lived experience of front line staff is one of constant pressure, reactive responses and decreasing resilience, whilst desperately trying to maintain quality. It is the human cost that concerns me most.

There are an increasing number of innovators within the health service who are challenging the existing tenet, recognising the limitations of a system built around ‘pathogenesis’. The cultural shift that we are beginning to see is one of recognising the importance of human relationships, working in partnership with people (and communities) to promote wellbeing.

We are fortunate in Ayrshire and Arran that we already have numerous examples of clinicians and teams working hard to make this a reality.

Integration

A big step in driving this agenda has already happened. Health and Social Care Integration will be a major catalyst for cultural change at scale and pace. I have been fortunate enough to be involved in the formation of the South Partnership, as interim Lead Nurse and the enthusiasm and commitment to delivering the cultural shift has been palpable.

The strategic plans of the three partnerships articulate the case for change and outline the steps that will be taken to work with people and communities to deliver care that is relational, enabling, anticipatory and sustainable.

So rebuilding the plane while it is flying will not be easy! There are a numerous challenges (or opportunities!) to be faced.

Some of the important ones that immediately spring to mind include:

1. It all about relationships – we need to carve out the time to talk to each other (communities, social care, primary care, secondary care etc) to build commitment and trust.
2. Configure around commitment to deliver change and drive peer influence.
3. We need to hold our nerve – the temptation will be to find immediate solutions (that will only reinforce the current model)
4. As individual health or social care professionals we need to reflect on the philosophy that underpins our practice (regularly). We need to become experts in facilitating rather than imposing our expertise – ask the question of ourselves constantly – whose needs are being met?
5. We need civic conversations about working together to foster a sense of individual accountability/control and shared responsibilities
6. We need to find innovative solutions to technical barriers e.g. a GMS contract that rewards activity rather than relational anticipatory care.

Humanising Healthcare

Cleary, this will not be an easy journey. The personal and professional identity of many will be deeply challenged as we journey towards the re-humanising of health and social care. The end goal is an integrated health and social care system that reflects the founding principles of the welfare state. I would also argue that this approach will not only be sustainable and nourishing but also affordable. The good news is we are already a good way down the road.

NHS Ayrshire and Arran in partnership with NHS Fife, NHS Dumfries and Galloway and NES, are hosting a conference called Humanising Healthcare on the 9^th and 10^th June to explore. This is a free opportunity to attend two days of sharing, learning and exploring health and social care today, the impact of working in this environment and what can be done to support staff to be more resilient.

Please contact Ruth Slessor for more details or to book a place – 01292 513671 or ruth.slessor@aapct.scot.nhs.uk

This week’s blog was by @maidenturret (Andrew Moore) Assistant Nurse Director, Quality Improvement and Governance, NHS Ayrshire & Arran/ Interim Lead Nurse, South Ayrshire Health & Social Care Partnership.