Blog

It was a real privilege to join West Essex Clinical Commissioning Group’s Board awayday this week, to which I’d been invited to bring a provocation around patient/citizen insight and ethnography. Whilst the brief family stories I shared on film and with quotes/photos were not primarily focused on health-related themes, CCG Board members needed no encouragement to grasp the implications for integrated commissioning of health and social care. They were clear:

• Patients/citizens and their support networks have energy and assets that we ought to build upon and support
• But all too often patients experience a system that is un-relational, un-personalised, and with which they need to do battle to get what they need
• Good health and wellbeing in the widest sense, including social connectedness, is a critical protective factor that deserves our attention if we want people to live happy, healthy and productive lives that ultimately cost the State less.

The discussion that developed was striking, in terms of the courageous way the Board sought to wrestle with and grasp the strategic and systemic implications of putting citizens, their capabilities and assets at the heart of commissioning. There were many significant issues raised (both opportunities and challenges), but comments that particularly stuck in my mind included:

“Is our core purpose as the health and care commissioning organisation to improve quality of life? If it is, how do we do it? This is a completely different purpose. We need a different way of approaching things, and a different way of thinking. We need to begin a longer and richer journey about turning our commissioning system (its processes, and tools) on its head.”

“If we are going to respond to this, we need to remodel our thinking. Who are the commissioners of care? It should be citizens and their families, with our support.”

“Recognising and building on patient/citizen assets and capabilities is absolutely critical. But the workforce simply isn’t equipped or incentivised to do this. How can we train them? Whose responsibility is that?”

“When we talk about co-production, we’re talking about asset based community development. The potential is enormous. But it’s not free: it needs resource to stimulate and drive it – even if it eventually starts to be self-sustaining. If we are serious, we will need to do some learning and unlearning of behaviours. Are we prepared for that?”

“What do we think quality means? I think it means the quality of people’s lives getting better over time. Do we agree that this is our purpose? NHS England doesn’t think it’s our job. We are living in an old-style NHS environment, that wants us to care essentially about mixed-sex wards, 4 hour waits, and patient safety. Even when the NHS says it cares about quality it pretty much means patient safety, with a small nod to ‘patient experience’. It’s not about understanding patients’ lives, aspirations and capabilities ,and harnessing those to secure better outcomes. It’s a clinical, medical, and incredibly narrow focus. This sets up very real tensions that will be a challenge for us as a leadership team.”

Recognising the scale of the challenge (and the opportunity) is of course the critical first step in addressing it. It’s pretty clear to us that this team has what it takes to move towards the vision. And we’re delighted to be journeying with them.