The Crisis in Health and Adult Social Care – Fixing the problems (1 of 3)

‘Ignoring the boring’

It is interesting in recent weeks that the crisis in the NHS is now the crisis in the NHS and Adult Social Care (ASC). asc1Those of us who’ve been working in the sector have known about this for a minimum of four years – and those of a more cynical nature would even say that some of the crisis in the NHS has been caused by the chronic underfunding in ASC and to some extent Public Health.

In some ways, it’s easier to focus on the NHS – it’s more immediate, a bit more exciting – with the cutting-edge technologies, the uniforms and flashing blue lights. ASC is just ‘boring’ old care. ‘Ignoring the boring’ is now coming home to roost.

Evidence is King/Queen

The Kings Fund and the Health Foundation have spent a lot of time and money outlining the benefits of prevention and better joined up care, which for the most part the Better Care Fund (and potentially the STP) Plans have paid lip service to in both the health and social care system.

The need for ‘evidence’ in health settings, which should support decision making, is absent and puts system leaders in a virtual straight jacket. This desire for evidence is understandable when organisations are under such financial pressure – and there are competing priorities about where to spend the money.

“the failure to provide adequate care in the home means elderly people are ending up stuck in hospitals, putting huge strain on their finances at a time when government is also demanding large efficiency savings” Clare Marx, president of the Royal College of Surgeons.

However, most people can see the common sense of creating independence and getting people to look after themselves a little better, so they do not have to rely on state provision. Those who are close to the front line know that in reality it doesn’t take that much effort and not that much money.

Small changes make a big difference. It is the evidencing of this which is difficult, if not impossible, as you are measuring behaviour change, which has a many factors and not just the smoking cessation programme someone may be on.

Addressing the Issues

There are several fundamental issues getting in the way of addressing the crisis:

  1. Budgetary and structural divides
  2. No real evidence
  3. Commissioning
  4. Supporting Social Workers
  5. Identifying real risk and mitigating it

We will address these issues over the next couple of weeks but our focus in this piece is on the budget divide.

Budgetary and Structural divides

A huge amount of progress has been made under the Better Care Plans in recent years to join up pathways and the funding that supports them. It is a complex landscape with different political and organisational drivers. If one looks at any strategic plan across a health and social care system, there is generally the aspiration to do the same things.

An enormous of time and effort goes into stakeholder management and governance across the system and this is often characterised by slow decision making. This is partly down to the system complexity but the primary reason is a lack of absolute clarity, agreement and common understanding of the aims, objectives, outcomes, outputs, inputs activities and therefore measures and then resource that drive the change.

Aligning the systems’ aspirations is a step that is often undercooked when system-level plans are developed. This leads to delays in decision making as leaders try to reconcile how the activities and resources support the aims of the system and their organisation.

Our Approach

At 4OC, we have worked on a number of cross system change projects in health and social care. Our key focus is on enabling this agreement and a common understanding. We are deliberately provocative to unearth what could be barriers to progress, we mark out what we think are the boundaries of acceptability in order to force leaders to challenge themselves and their organisations on the appetite for change.

What we do is to clearly differentiate between what are real barriers and what are constraints that need to be managed. We use our considerable experience of change programmes to create scenarios that bring future decisions to life. This articulates the risks and mitigations, and more importantly the consequences of these decisions and a mechanism for managing these so that leaders are informed and can make critical decisions in an overall context.

If you are interested in hearing more about this, or indeed any of the other services we provide, contact us at or by phone on 0207 928 3127.


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