Aren't We All Experts?

When the going gets tough, organisations rearrange themselves.

Although the reasons are more pressing than ever, this time there is more emphasis on data and there was a very interesting presentation from Professor John Bolton.

He told us that the outcomes of reablement and community services, of which Medequip is a partner, are only partly dependent on the efficiency and effectiveness of said services. The experience of people whilst they are in hospital differs across hospital trusts and has an impact on where they are discharged from hospital to and how well they can recover.

So, integration is really important, to make sure organisations within the NHS and their local authority, voluntary sector and private sector partners are all working well together and keeping the person at the centre of our thinking. But this integration can’t be one size fits all and has to recognize the pressures, capacity and strength of local communities and institutions.

Otherwise it’s just rearranging the deckchairs.

The NAEP audience heard a very powerful presentation from Gill Creighton. She used her OT expertise in equipment and training people in moving and handling techniques, to reflect on what it was like from her own personal experience of illness and disability when she herself had to be moved and handled. As well as the clinical and technical lessons she had for the therapists in the audience, there was one thing that stood out for me. What notice do we take of how people feel when they are being moved and handled? How do we see people as experts?

Medequip have had its own experience in asking itself this question.

Thanks to the involvement of people with lived experience in producing our new generation of surveys, we are now asking people how they feel about the difference the equipment we provide has made, as well as their experience of the delivery, maintenance or collection. Just asking people how they feel starts different conversations.

You know how some people shout out their challenges? They use capitals, bold, loud voices or attention-grabbing messages. Well, the two speakers at the end of the first day did exactly the opposite.

Through their quiet but powerful presentations Bryonny Shannon and Anna Severwright challenged the very core of the current system. Asking us all to stop using language that sets people apart, and to make sure people who use services are at the centre of everything we do............and not just metaphorically. On the Teams call, round the table, in the room. For the direction, implementation and reviewing of what is happening across the system.

So, in the mind of a non-expert, there seems to me a few key challenges for the architects of the latest push on integration.

Make your changes on who reports to who, how the money flows and which meeting can make what decisions.

But at the same time put in the work to build proper partnerships.

Most importantly with the people who ultimately pay for them and use them to help them lead their lives.

Families, neighbours and communities need to be involved too. If the system supports them and doesn’t take them for granted they will continue propping up our underfunded systems.

Community organisations, large and small will always be involved and bring in a significant amount of other peoples’ money through grants and fundraising, but all too often we see statutory organisations creating barriers to funding, other forms of support and partnership working needed to coordinate and focus activity where it’s most needed. And I don’t mean according to a LA or NHS performance indicator. I mean what a local community says is important to them.

And let’s not forget the private sector, without whom the whole system would fall apart. I’m not here to get into the politics of all this, but the private sector is an integral part of our lives, in nearly every respect. There needs to be close oversight of this in the care sector to stop the worst kind of private sector organisations simply extracting money from the public sector. Luckily for us we are seeing increasing numbers of tenders emphasizing that providers need to bring their own innovation and partnership-working skills to the table, along with their own commitment to treating people as experts.

To summarise, people with lived experience, their families and communities must be appreciated as the experts that they are.

If the people reorganising health and social care can recognise this and include people at every stage, use local data, make local decisions and stay accountable and transparent, then there is a chance good things can come from these latest integration efforts.

If it is overly prescriptive, ignores the expertise of people, communities and the private and voluntary sector organisations that work with them, if it is experienced as a top-down process, then it will be a wasted opportunity.

The experts in charge of the reorganisations need to truly believe that we are all experts.