This is looking like it will be increasingly problematic for private providers like Medequip and those in the voluntary, community and social enterprise sector who supply goods and services to health and social care.

Whilst we are promised further details, the Budget headlines on increased National Insurance contributions for employers, the increase in the Living Wage, and alongside an increase that many believe is too small, the requirement for the NHS to find further efficiency savings, suggest to me that we have some very difficult conversations ahead of us. The Local Authority and NHS contracts that we sign are simply not equipped to deal with these sorts of increases. Neither in the detail of the price increase mechanisms in the documents, nor the organisational decision making, nor the cultural shifts necessary to enable significant change in models of contract delivery during the life of a contract.

That’s before we consider what quality means to the people who use services.

There is a school of thought that quality simply equates to compliance with expressed requirements. As the advert says “it does what it says on the tin”.

But from my experience, and through the work we are doing with people who use equipment services, I am coming to the conclusion that any work on defining quality has to be more firmly based on what makes the most difference to people, and that this has to encompass the whole connection of organisations that impact their lives.

I’m not against counting things, but I don’t think we’ll find the answers in the Key Performance Indicators measuring activity of the separate organisations involved, or in the data collected in aggregate from across the networks, places, Local Authorities or Integrated Care Systems.

Whilst the data can provide some structure, it’s peoples’ experiences and narrative that make for a compelling story.

But let’s go back a bit to see what’s in place to monitor quality. Let’s start at the top.

How does anyone know that their local Council and NHS services are well run and delivering efficient and effective services?

NHS England has an evolving Quality Assurance and Improvement framework, and I’m told, plans for annual assessment of Integrated Care Boards. The NHS also has a reputation for the collection and reporting of data.

Local Authority social care for children and families has been inspected by OFTED for a while and more recently the Care Quality Commission, as well as inspecting registered providers has been inspecting Local Authority arrangements for the provision and commissioning of adult social care. I know they have had some difficulties recently but I’m assuming they’ll sort that out.

The Directors of Adult Social Services also submit a range of data to DHSC, who also regularly survey, and Local Authorities more generally have to be transparent and accountable to Government, as well as their local population.

Getting closer to home, like most community equipment suppliers Medequip is a member of CECOPS – a not-for-profit organisation that sets standards, accredits and inspects assistive technology and equipment services.

We also use ISO 9001, the well-known and widely used and often required, quality management system ensuring business improvement.

Alongside these we have various legal requirements and industry standards we adhere to in health and safety, data security, recruitment and sustainability.

Building on these, we are increasing our transparency by working alongside local Healthwatch organisations to collect feedback from people and to report back to them on what we have changed as a result.

We are also developing our relationships with and reporting to people using equipment services, through our co-production group, Equipment Matters.

So, broad brush, if the money’s too tight to mention and there are other Quality Assurance processes in place, shouldn’t the joint effort of providers and commissioners be on understanding and ensuring quality from the perspective of the person using the equipment?

Our most productive conversations with commissioners on cost, price and outcomes have been when there is a focus on the big picture and how we work together.

Whilst it’s always important to get the detail right, starting and ending with it won’t radically change how things are done, how quality is demonstrated and how outcomes are achieved.

For many years the starting point for specifications for equipment services seems to have been the current service. Purchase, store, distribute, maintain, repair, collect, recycle.

Repeat.

At the same time, the demands on the NHS and Local Authorities have resulted in a procurement and contract monitoring landscape that sometimes feels like a race to the bottom, with little value placed on relationships between organisations, and between organisations and people.

If it sounds like I’m asking for a unified theory of everything it’s because I think that’s what’s needed.

That would look like everyone involved in agreeing how we should frame the issue of people needing different levels of support, technology and equipment to live their lives at home.

Then those most affected being involved in the discussions with a variety of types and sizes of organisations and groups to develop and deliver solutions.

And most importantly, the people drawing on that support then deciding what quality looks and feels like, and keeping an on-going eye on things to make sure that happens.

I know in my bones that we are going to have to have those difficult conversations about performance and cost.

My hope is that, if we can all focus on quality as it’s experienced and defined by people who use services, at least one of those conversations starts with “what can we all do differently”?

So, if you see me on the Medequip stand at NCASC in Liverpool, why not stop by and try that line on me and my colleagues.

I was in the audience for a conference last year when there was a standing ovation for the announcement that the Welsh Government, in response to some well publicised examples of bad practice and excessive profits, were moving towards no longer allowing private sector companies to provide residential care for young people with complex support needs.

And I’m a fan of the increasing recognition of the role of voluntary, community and social enterprise organisations in delivering public services.

So, managing a private company I was a little wary of writing about money at a time when there is a lot of pressure on the system.

But, as a large employer, working with many British manufacturers, and increasingly hearing directly from people who rely on community equipment to live their lives, I decided it was too important to ignore.

Across the board, Medequip’s costs have gone up. In every substantive part of our business things cost more now than they did before, in some areas a lot more.

We’ve committed to the Living Wage and have a developing programme of co-production and community engagement activity. Add to this the requirements to achieve carbon and other sustainability targets, the drive to make services more personalised, and the extra activity needed to support the NHS.

What you get is a perfect storm. An immeasurable force meeting an immoveable object. At least that’s what it feels like from my side of the discussion.

The contracts we sign have a variety of clauses on how the commissioning organisation will deal with inflationary increases and it seems commissioning organisations have a variety of models for budget setting and dealing with increases in activity.

But my view is that, if the health and social care system is serious about delivering the kinds of outcomes described in the ADASS report Time to act: a roadmap to reform care and support in England and the NHS Long Term Plan then some things must change.

Budget can be a noun, budget can be a verb, or budget can be an adjective. What budget is not, is fixed. It can set the parameters, it can set the tone, and it can be used as a planning tool.

Too often I see historically set budgets for community equipment services being used by Local Authorities and the NHS as a sort of doctrine with little evidence of its origin and development.

Commissioners may not have the capacity or authority to conduct a zero-based budget exercise, but why not do some benchmarking?

As a national provider, working with a wide range of Local Authority and NHS commissioners, we can offer a range of anonymised benchmarking data that can help in local decision making about effective use of public money.

Transparency, by definition, must work both ways. If I show you mine, you show me yours. Entering negotiations with public sector organisations can sometimes feel like entering a parallel universe. A sort of do as we say, not as we do type of situation.

Medequip is very transparent about its costs, profits and pricing and works very hard to be efficient. Indeed, the reason over 60% of community equipment services in England have been outsourced has been because of evidence and feedback that the private sector can run these services more efficiently.

I see plenty of evidence of public conversations about how community equipment, assistive technology, the voluntary, community and social enterprise sector, and a host of other things can save money in the system. The trouble is they seem to be happening outside of the budget setting process or driving the discussions about inflationary uplifts.

Innovation is a bit of a buzz word right now. In my experience of working with the public sector it’s often a synonym for cheaper, and, with some exceptions, often requires “other” organisations to work differently, not one’s own.

I’d also say much of the system has got used to thinking about, or for, the people who use the services, rather than with them. What Medequip and I are learning from the work we are doing to involve people is that we might all be seeing what we have always seen. Involving people helps us question why things are the way they are. That’s when innovation happens.

For example, I get it that public sector organisations are different, big and complex but we see a diverse range of approaches to dealing with the challenge of internal overheads and the actual cost of the in-house activities that form part of the overall cost of the system.

It is often political views and history that determine how community equipment and other services are provided, rather than evidence-based assessments of costs and outcomes.

For example, why are we discussing shaving a few pounds off the cost of an activity or pieces of equipment when a private or VCSE organisation could save many pounds in the costs of doing assessments and reviews by adding these tasks to existing community-based services. The Trusted Assessor model can work for external organisations too.

There are also different approaches to borrowing, use of investments and reserves, and the use of joint funding arrangements between health and social care.

Now we have a growing body of Local Authority inspection reports from the Care Quality Commission, we can also begin to see the variations in efficiency and effectiveness across the range of themes and outcomes used in these inspections.

All of which has an impact on the budgets.

All of which has an impact on discussions with providers on uplifts.

Partnerships work best when each partner is motivated to help the other partner succeed. That requires each partner to value and respect the other.

I see that this can be a challenge for people in the different parts of the statutory sector of the health and social care system. The Integrated Care Systems are a work in progress, more developed in some areas than others.

I know Local Authorities were frustrated by the option within the NHS of cross-subsidy or bailing out of NHS Trusts in deficit, by those that had managed to stay within budget.

For Medequip, we feel the same frustration with the current arrangements for discussions with Local Authorities and the NHS about inflationary uplifts and other cost pressures.

Aren’t the well-run Local Authorities and NHS organisations effectively subsidising the less well-run?

Partnership becomes even more of a challenge when you introduce values-based differences of opinion on whether the risk of profit and loss should be held privately, or publicly. All sorts of personal and organisational issues are at play.

But we have the system that we have, and as I have said previously, Medequip is determined to be a significant partner to the statutory organisations in health and social care. Our mission is to keep people independent and I am proud of the way this business is run to achieve that.

So, we will enter discussions requesting inflationary uplifts and other cost issues, respectfully, transparently and with a sense of responsibility for our role in the system.

My hope in writing this is that if you are reading this in a Town Hall, or NHS office, you come to your next meeting with us in the same way.

Not just as individuals, but how we interact with each other.

Members of Equipment Matters, a co-production group Medequip is part of, reminded the conference attendees in a workshop and main stage speech how important it is that the people who use community equipment are central to these interactions. You can hear from them directly in their blog about the conference.

Increasingly we are seeing tenders for community equipment and associated services being awarded for longer contractual terms and referring to the need for “working together” to address current and future challenges. It’s not just about delivering stuff!

The speaker and workshop line-up arranged by the NAEP conference organising committee reflected this relational, rather than transactional approach. And as ever, the tone set by the redoubtable NAEP CEO Jean Hutfield, and all the organisers was matched by the enthusiasm and generosity of the exhibitors and attendees.

It was great to catch up with colleagues from across the various organisations, and to hear about specific equipment innovations, learn from the experience of service developments and hear how challenges had been overcome.

I particularly enjoyed hearing how one Local Authority-run service in a rural area was having to adapt after boundary changes and I hope they didn’t mind me giving a bit of advice on efficient ways of segmenting large industrial units.

Here at Medequip we are all about sharing the journey and we have always worked hard to build and maintain strong relationships with the manufacturers and suppliers of community equipment, the NHS and Local Authorities who commission our services and the clinical and social care staff who assess people and order the equipment.

But as I look across Medequip today, I see a much wider and deeper range of partnerships and relationships that are integral to the work we do. From the mother of a disabled child now running her own training company “Born at the Right Time”, to the collective of churches in Sheffield, Sheffield Churches Council for Community Care who provide services to support hospital discharge.

From Community Catalysts the organisation that supports development of micro-enterprises in the community, to BASE (British Association for Supported Employment), who work to improve the employment rates of disabled people.

So, as I reflect on my conversations, catch ups and introductions at NAEP, I thought of Medequip, and how we directly and indirectly touch the lives of so many people.

I believe, it is through the individual and organisational relationships we build, as much as the transactions of stuff we efficiently and effectively complete, that we achieve our aim of helping to keep people independent.

The background

Back on earth I’m still collecting my own data to help me and the team at Medequip to work out what’s the direction of travel for the equally complex system of health and social care provision and who, or what, is driving it.

So, I started at the top. Maybe I am being unkind, but apart from the “pressures”, by which I think they mean people, and the money, and more commitments to “sort things out”, none of the main parties seem to have much to say on health and social care.

Local Authorities are supposed to use Market Position Statements and pre-tender market engagement events to communicate their priorities and intentions with the market of providers who are needed to provide the day to day support to people.

Strategies, vision statements, position papers and the like, together with their supporting plans, are also often positioned as “opportunities to get involved” and are supposed to set out a clear destination, and a practical route to get there.

For a large organisation like Medequip there needs to be a clear sense of direction, but as a conscientious user of public funding, how much time can my team spend in different public sector meetings, especially when there seems to be so much inconsistency?

Despite the vision and call to arms in the ADASS Time to Act report, for every Community Equipment, Technology Enabled Care or Wheelchair service specification that references the work and vision of Social Care Futures there are several more that start with reference to an existing or potential Section 114 notice or a more general note on the parlous state of a Local Authority financial position.

The amount and quality of involvement of people who use services varies greatly too.
I have been very public in talking about Medequip’s work in this area being “early stage” but I naively expected any organisation with a statutory duty under the Care Act 2014 to be well and truly committed.

So, I am left trying to explain to the Medequip Board and the owners why it is so important that we continue to involve people and the local communities, and whether the Local Authorities and NHS will want a few large distribution centres, basic equipment and technology and a high degree of standardisation?

Or if, as some commentators suggest, the future is about personalised services and equipment, local connections and small community organisations?

Will there be a continuation of the trend to outsource services, will they be taken back in-house, or is the future about new arrangements and partnerships between statutory organisations, private sector providers, community organisations and the people who use services?

I don’t suppose I will ever find “the” answer, and I suspect, as with most questions about complex systems, it depends on who you ask, what and when you ask, and just as importantly what you want to hear.

I would like to think I am known as a generally optimistic character, and I certainly don’t want to be the guy who says “Houston, we have a problem”.

So, I promise to let you know if I find out who or what is driving social care and the NHS and in the meantime Medequip and I will work with the different points of view to find the best solutions we can.

Unlike Voyager One, we might not be navigating the frontiers of known knowledge, but sometimes it can feel exactly like that.

Now, I am no time-management guru, so I’ll leave that topic for others.

But I saw the news headline last week about people who need NHS funded care and support and who are often affected not just by cuts in funding, but by delays in decision-making - Families of disabled people tell BBC of battle for NHS care support - BBC News

I also remember one of our equipment suppliers telling me that they had worked much harder to reduce their production times for personalised equipment needed for young children, when they were confronted with the reality of reduced life expectancy.

Medequip takes pride in meeting key performance indicators for meeting the delivery speeds for community equipment. We know that delivering equipment quickly can make a difference to when someone is discharged from hospital, or prevented from being admitted in the first place.

But, in response to feedback from people who use equipment, we are also looking at convenience, as well as speed. If you need someone to help you receive a delivery, or you need to avoid a clash with other care tasks, the option to choose a time may be more important to you.

One of my team recently attended a Social Care Future gathering looking at the “plumbing and wiring” of social care that makes it harder to achieve the Social Care Future vision. A lot of Local Authority staff reported that time pressures and a lack of capacity mean they find it difficult to cope with all they are expected to do.

I can tell you, people working in voluntary and private sector organisations are feeling the same way.

But waving our pressures and deadlines at each other is not a good look.

Instead, I suggest we consider how time is moving from the point of view of people who draw on care and their families.

Whether that means a community equipment provider considering convenience as well as speed. A funding panel looking at how it makes decisions, or a procurement team shortening a process to get a new service in place.

Sometimes we hear organisations and systems can only move at the speed of trust. Maybe from one perspective that is true. But when you next get the chance, don’t just ask someone for the time, ask them about their time.

It was lovely to meet people we have been working with for some time, others who we are looking forward to working with in 2024, and some who just wanted to hear what Medequip has been doing, and how it might help them as they plan for the future of their services. It’s amazing how many people will stop for a chat if you are giving away cuddly soft toys.

Both conferences emphasised that in the moments when the system is short of time and money, there is even more reason to work alongside people who draw on care and support. Because it is only then that we can be sure we are spending what money there is, on what is important and what works.

Both conferences had a focus on integration and joint working between health and social care, and in both conferences I heard how difficult it can be finding the key influencers and leaders. All I can say to that is it’s even harder if people and systems keep you at arm’s length. Medequip have joined the #SocialCareFuture Big Connect, a community of practice of provider organisations that won’t settle for being described simply by the services they provide, but want to play their part in the wider community.

The most exciting things in Medequip happen where local people, local organisations and the NHS and Social Care, work together to find ways of trying new things, or find better ways to do things we have always done.

I had to do a bit of a double-take in Bournemouth when I turned up to find colleagues wearing spectacularly large underpants over their outfits. But now understand more than I did about the work of Camerados and Curators of Change. Two ways of looking at the world as much as they are organisations, and very willing role models for working together.

Keep an eye out for “public living rooms” at future Medequip events!

Both conferences heard from CQC about the plans for assurance of Adult Social Care, and although Medequip is not a registered service, please do reach out if we cover your area and I or my team can help in anyway with the preparation of your evidence file.

It can be a difficult time for some people over the holiday period, but the Medequip vans and responders will be out there and I’m ever hopeful that in 2024 we will all realise that we are better, stronger and more resilient together.

I think this must be a work in progress because I read that the number of people using Direct Payments has gone down every year since 2015 and it has never been a big part of our work in Community Equipment or Technology Enabled Care.

However, I do see a lot written about choice and control, personalisation and outcomes, in the specifications that cross my desk for Community Equipment and Technology Enabled Care services, so I am guessing that these are still required.

And I have seen examples of Direct Payments working, or working well-enough, so that people do have some choice and control in how their care and support is arranged.

But what does any of that mean when Local Authorities and the NHS are strapped for cash and struggling, or failing, to keep afloat. Especially when that means there is pressure on managers, clinicians, and prescribers to restrict funding or gate-keep services.

As a long-term fan of Newcastle United, I am used to not getting what I want, and in my mind “personalisation” does not mean anyone who would benefit from some support, having whatever they want, whenever they want it.

To me, it starts with an honest and open conversation between people who draw on care and support, and the people and organisations that make a living arranging and providing that care and support, including Local Authorities and NHS organisations.

That’s what is happening across the Medequip depots and services. We are not experts in engaging with communities, so we have organisations like Community Catalysts and Healthwatch helping us, the Think Local, Act Personal Making it Real framework to guide us and the Social Care Future movement to inspire us.

Through them, and from people who have used our services or the services of other organisations, we have learned many things about how we can make our service better and how people want to live their lives.

Where there are other people responsible for making decisions, we have helped make introductions, for example, on the sorts of equipment we can provide, or the timescales for collecting things.

Where there are things we can change directly, we get on with it, and where there is more of a culture change involved, we look outside our organisation for support, and for challenge.

I won’t stray into the legal area, some might call it a quagmire, of how a Local Authority decides how much money to allow someone to have, for example to pay for Home Care or other services that can also be provided through contracts with various provider organisations.

But let’s just say it gets difficult to unravel the costs of sourcing, delivering, maintaining, repairing and collecting equipment to support people in their own home. Especially if you have a unit cost based on a large company loaning equipment on behalf of the Local Authority to lots of people in an area.

But I do believe in personalisation, if it means seeing people as people first, and in working with them to understand how they want their care and support, and maybe community equipment and Technology Enabled Care provided.

Does this mean starting with a more hopeful view of what people want to achieve for themselves? Yes, it must do.

Does this mean starting with a realistic view of the funding and other sorts of support available in a community? A big yes to this too.

But, it also has to mean that we all take a long hard look at the way we do things. Things that we have got used to and see as part of the way we have always done things. Like who does assessments and reviews, how much choice people have over types of equipment, and the balance of convenience and speed.

I take heart from the increasing number of contracts that require organisations to be innovation partners and that commit commissioners and service providers to work together alongside people who use services.

And I am inspired by the positive and negative feedback we receive from people and the continual efforts of the Medequip team to do their best.

So yes, I support Newcastle, and yes I support personalisation, both are fundamental to me, but I make sense of both of them by believing in and supporting people.

Money and systems may have to move around and evolve for personalisation to work the way the original campaigners hoped for, but if you believe in that, and the people involved, there is a better chance of this happening.

If you are ready to ask different questions about how Community Equipment and Technology Enabled Care services can play a part in the personalisation journey in your area, get in touch, Medequip is ready to help you think of some different answers.

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.

We’re all aware of the significant issues facing what we know as social care, and I had my own experiences recently with my mother-in-law as mentioned in a previous article.

But as a lifelong fan of Newcastle United I’ve learned to learn from the doom merchants but be motivated by more positive voices.

So, although this ADASS report covers familiar ground, and doesn’t underestimate the short and long term tasks, I was heartened to see so much optimism about the future possibilities.

And, especially pleased to see the central role of co-production with people who draw on support, and the reference to the Social Care Future vision and the Making it Real framework developed by Think Local, Act Personal.

The world of Community Equipment has never been seen as a top priority in regards to its place in discussions on funding, the workforce challenges, and the personalisation of outcomes.

But the times they are a-changing.

At the Medequip-sponsored National Association of Equipment Providers annual conference this year we will hear from a range of speakers, including a new voice for Adult Social Care, Bryonny Shannon and one of the architects of the Social Care Future movement, Anna Severwright

And, Medequip has been on its own journey.

From changes to our process of collecting feedback, work alongside Community Catalysts, Healthwatch and local community organisations, to setting up our national co-production group, Equipment Matters, to both challenge and support this journey.

We’ve even held out our hand to local authorities who want to continue providing their own in-house community equipment services, as a partner in their own journey.

I won’t try and summarise any more of the report, there are many voices better placed to do this than I, but as ADASS and the authors say…..

“That means this is a challenge to all of us. To Directors of Adult Social Services, to lead change with our communities, so care and support genuinely enables people to live fulfilling lives. To our public service partners, corporate colleagues and providers in the private and voluntary sectors, who all need to contribute to a better future. And to everyone in England to participate in a bigger public conversation about the importance of care and support and to agree a new social contract on how to fund social care and what we can expect from it”.

If you are one of Medequip’s existing partners, are considering buying our services from a framework or are thinking about how the provision of community equipment can improve outcomes in your area in the context of the ADASS roadmap, why not get in touch with me for a chat.

David Griffiths, Managing Director, Medequip
d.griffiths@medequip-uk.com

Thanks to the partners we have been working with, we made the shift from being Exhibitors to being Listeners, and it is amazing how much more you find out when you set out to listen. Especially when you include some of those partners and people with experience of using services as part of your “listening team”.

We heard from people we are working with how grateful they were for our efforts to keep things going, despite the pandemic and the global supply issues.

We heard from people we are not working with how interested they were in the clinical and community developments we are working on.

We heard from a lot of people running their own in-house services how they were moving from surprise, to curiosity and on to consideration, of the Medequip and Community Catalysts project offer to Share the Journey.

And along with most of the attendees, we heard that despite the many issues facing us, the #socialcarefuture vison is a powerful, engaging and compelling call to action.

The Medequip team who attended the British Association of Supported Employment conference in Leeds had a great response too.

It makes perfect sense to us to be a great and inclusive place to work; it makes things better for everyone. So, it was lovely to have people complimenting us on the culture of the organisation, the employment opportunities we have created for people facing barriers and the systems we are putting in place to report on our progress.

Could I get away with a football terrace chant in praise of Medequip?

Best not. Leave it to others to sing our praises.

We’ve still got a lot of work to do.

But I’m determined that we will enjoy, and Share the Journey.

Supporting the health and social care system is an important and demanding task in the best of times, and I wouldn’t say we are in the best of times.

Against this backdrop I find it very challenging, balancing my work life with my personal life. But as someone said, if you enjoy work, finding that balance isn’t quite so hard.

So, I’m always really pleased to hear feedback from people who use the service that shows Medequip staff really care about the service they provide.

Professional, knowledgeable and respectful go without saying. But staff who have been empathetic, patient and kind and put themselves out, can really make a difference to someone’s day. And that feedback helps people find their own balance.

If you have employment that you enjoy, with people you care about and who care about you, then you’ll realise how unfair it is that many disabled people, or those who face barriers into employment don’t have the same opportunity.

That’s one reason Medequip is working hard to be a more inclusive employer. The other is that it makes business sense. Two great reasons to try harder.

Across the country we are Sharing the Journey with Local Authority contract partners, local Supported Employment agencies and Apprenticeship providers. For some people, it’s just some practical adjustments to their workspace that makes all the difference. For others it requires different organisations to work together with the employee, their family or network and their co-workers.

Medequip can’t be experts in everything, but we can proactively reach out and find that expertise to help us be better.

You’ll see more in this newsletter from Kamran Mallick, CEO of Disability Rights UK who is helping us shape our policies and culture. The national work of Laura Davis and the British Association of Supported Employment and the work going on in Birmingham with our own Jo Page, the Local Authority and a number of partners.

Whatever it takes to increase our inclusiveness, we find it makes us a better organisation. More aware of each other and how we all contribute differently. More aware of our purpose and what we need to do to help people stay independent for longer.

More able to find that balance.

Medequip have been on a journey of improvement, and truth be told, working in the Health and Social Care system, the destination, whilst always in sight, is always some way off.

That is why we want to do our best today, and tomorrow, for our contract authorities, suppliers, community partners and the people we support.

So, when someone asked me if we ever partnered with or helped in-house Community Equipment Services, I couldn’t think of good reasons why we weren’t and I was curious about the people we would meet. We got our thinking hats on, thought about what we could offer and so the idea of “share the journey” was born.

Share the journey is a three month, fully-funded project team, offered to three Local Authorities or NHS organisations that provide their own, in-house Community Equipment Service in England, Scotland or Wales. We have partnered with the innovative social enterprise Community Catalysts to help us deliver something different.

Whether you want to benchmark your service against best practice standards, reimagine how the service could develop, or simply take stock of where you are, a Share the Journey Project Team could be the answer.

Medequip and Community Catalysts will offer your organisation support, bringing in dedicated people with specialist skills once you agree. You would also be expected to enable key staff to participate. People using the service and local community groups should be included too.

What’s the catch I hear you say. What’s in it for Medequip?

No catch. We just all learn a bit from each other and improve things for people who use our services. I have committed Medequip to its own journey of improvement and I think there is a lot of learning out there and a lot of good stuff Medequip and Community Catalysts can contribute.

The simple application process is explained in more detail in the newsletter, along with stories from people who work for Medequip, suppliers, partners and people who are helping us improve.

I hope you will consider this offer and if you want an informal chat about how this might work for you, please drop me a line.

David Griffiths, Managing Director, Medequip
d.griffiths@medequip-uk.com

I noticed how we all acted differently, and at different times, to the challenge of the change. Denial, anger, bargaining, depression, and acceptance, the classic grief stages.

If life was a bit neater, we would have all experienced the stages in the same order and moved on at the same time. But as life's small print says "no guarantee of neatness can be made".

I've seen the full range in the Griffiths family, so you can imagine the variation in Medequip, with over 1000 people.

As an organisation, and as a group of people, we are ambitious to get better, on a large scale and in small details. This has meant constant change is the new normal and we have had to make sure we understand that change affects everyone differently.

Change is a bit like consistency, sometimes we resist it, sometimes we embrace it so enthusiastically we get a bit carried away. It is quite nice to focus on something new rather than finding renewed focus to improve something that is not working the way it should.

But, when change is required, I've learned that some of us need encouragement, some of us need support, and some of us, well we just need a bit of time and space to process stuff in our own way.

And it's the same with the people we serve, the communities that support them and our statutory and voluntary sector partners. They are all affected by layers and layers of change, experienced by many different people, in many different ways, at the same time as everything around us is changing.

There are things we are learning that help.

Involving people who use services keeps the focus on what's important and can unite different perspectives.

It's not just the big stuff that matters. Keeping an eye on the little decisions that get made every day helps make sure they are moving us in the right direction.

Of course, a good level of communication with people helps, especially if that involves checking in regularly, making sure people understand why the change is necessary.......and my personal recommendation, recognising their efforts and thanking them.

So, I'll wrap this up by saying thank you to all the people that love Mary. Like a lot of change, it wasn't really wanted and the process hasn't been easy, but by going through it together, in all our different ways, we've managed.

I have also been amazed by the resilience of the people we support and their families, the many fantastic community organisations out there, and the wider health and social care system. It’s a system of many moving parts and I am extremely proud of the part played by Medequip.

Through our mature relationships with supply networks and our experience in joint working with Prescribers, Commissioners, and local organisations we were able to maintain, and in some areas help with additional services, which has been so important to peoples’ quality of life and independence.

Through 2021 Medequip has continued to grow and is now working with more partners than ever. So, as a national organisation, in England and Wales, across cities, towns, villages and some spectacular countryside, I am more determined than ever that the Medequip service offer works alongside local communities. We use local businesses wherever we can, and we recruit locally. I have asked Community Catalysts to support us build a community feedback process, and each depot is building links with local organisations to ensure local people are involved in improving things.

As a leading organisation you might expect us to have a lot to say. We do, where we can add value to local or national conversations. For example, in improving the hospital discharge process, in prevention and early intervention, in the switch to Digital Telecare services, and always in increasing efficiency and effectiveness.

As a leading organisation you might also expect us to perform, and we do. Despite significant inbound supply chain issues impacting on the UK we are still completing over 99.2% of our activities on time.

But you might not know we are also an organisation of big listeners. Not passively. No, we believe listening is a doing word.

- If the NHS is to achieve its ambition of proactive, place-based health and wellbeing services,

- If Local Government wants to support people to live in places they call home, and

- If communities want to be involved, respected and supported….

For 2022, we are listening.

The report goes on to say that 43% of 521 of the largest organisations in the world underperform on environmental, social and governance issues despite investing in them.

It’s probably fair to say that whether you run a private, public or voluntary sector organisation, these areas will always be a work in progress.

I’ll save the environmental update for a future blog, but for now, I’m thinking to myself, as a private sector organisation delivering public services, how do I measure how well Medequip is doing to meet its core purpose.

I know we provide monitoring reports to Commissioners on each of our (41) contracts.

We also have customer care teams to contact people who use our services to see how we did.

And then we have a whole range of internal quality assurance and external audit processes, including all the industry-standard ones, plus recent applications to the Think Local, Act Personal Making it Real commitment Making it Real - Think Local Act Personal and the Department of Work and Pensions Disability Confident employer scheme Disability Confident employer scheme - GOV.UK (www.gov.uk). More details on these another time.

But do any of these tell me if Medequip is achieving its purpose of keeping people independent, and happier, for longer? Not really.

That requires a system-wide definition of the issues, agreement on the metrics and the process of collecting, analysing and reporting on the data, and most importantly a commitment to hearing the voices of people who use the services.

The work to bring health and social care together in Integrated Care Systems will help with this, but there is no guarantee every ICS will come up with the same approach to data or working with people who use services and private sector providers.

So, to my mind, we all need to work harder at getting a systematic and evidenced response to the question - have we helped people stay independent, and happier, for longer? This means we have to find answers that are good enough for now, at the same time as working to find better answers in the future.

Which reinforced my belief in the journey we have embarked on to get better at co-production and community engagement. Because, with the utmost respect to our Commissioners and the contracting authorities that employ them, it is the people who use our services, their families and friends and the communities that support them that we need to hear from, and work with, to answer the question.

I’d like to tell you I’ve found a simple answer, but I can’t.

But I can tell you the answers are simple.

The first of the Medequip values is to do what we say we are going to do - To keep our promise. That’s a good start.

Next, we will continue to listen and learn. My team and I have had some amazing conversations recently. Passionate Commissioners, inspiring voluntary sector leaders, committed and loyal staff, and we are putting the infrastructure in place to have more direct conversations with the people who use our services.

We know everyone is busy keeping the show on the road, but if you can make time to talk to us, please do.

Finally, we all know numbers count, but so do stories too. Recently Medequip had a very busy month, our busiest ever, in fact, knocking on an average of 4,700 doors a day.

It’s an impressive number, but behind each of those doors is someone with a story. We already have systems in place for counting activity, and we are working with Commissioners to improve the reporting of the difference we’ve made.

But to hear more of the stories, and to learn from people and the community groups that support them and how Medequip can help deliver on its promises, we are working with Community Catalysts Social Enterprise and Community Interest | Community Catalysts to help us co-produce a community feedback process.

I can’t promise we’ll collect 4,700 stories every day. But I can promise we’ll do more, as we continue to find ways to evidence our purpose of keeping people independent, and happier, for longer.

So, I was very pleased to hear in National Co-production Week (5-9 July) that, in one of our contract areas, we are working with the local Healthwatch to collect people’s experiences of using our service. This is a great piece of joint-working.

Whilst Medequip has a long history of keeping people independent for longer, it is the Healthwatch organisation in each area that has the skills, and indeed the duty, to enable people to shape, influence and improve NHS and social care services.

I look forward to working with the commissioners and Healthwatch to continue building on the efforts of a great many people who have kept the services of both organisations operating in such difficult times.

In addition, Medequip is working with a community development organisation to make sure we have a model of feedback that involves the wider community too. I’m very excited about this work.

Lots of people and organisations, including Medequip are rightly talking about “working with the community”, and we have already taken some practical steps towards this. For example, we recently made a commitment to work with the Huddersfield Giants Community Development Foundation.

But as I talk to people across the country, in areas where we already work, and in areas where we think we could provide a great service, I’m learning that “working with the community” means many different things.

That’s why I asked for help.

Each area has its own unique organisations and challenges as well as dealing with many common issues.

The pace of NHS and social care integration is different.

Some areas have more well-developed infra-structure and funding arrangements to support the voluntary sector. Rural and urban areas are obviously different, but so too are the large metropolitan areas.

For a large organisation like Medequip this means arranging our work on co-production and community engagement flexibly, building our skills and supporting our people. Sometimes it means thinking small, sometimes big. Sometimes technology and data will be the answer, sometimes it will only play a small part.

Whatever the case. I promise that myself, and Medequip, will be curious, ask questions and listen carefully before jumping in with our (my) ideas on what’s needed.

So, to finish, recently I was pleased to see a potential Local Authority partner requesting bidders show how they would use an “ethnographic approach” to developing the service. Someone we work with described this as the process of “deep hanging around with people”.

I think he means getting to know people and listening to them and I think that’s another great way Medequip can help people stay independent for longer.

If you are an existing or potential partner of Medequip, or use our contract or retail services why not get in touch to let me know what you think.

The company had grown to be the largest provider of Integrated Community Equipment Services in the country. With nearly 1000 employees, 40 contracts delivered from 23 depots, new services in development and a turnover of nearly £190 million.

But this wasn’t a journey to get bigger, or faster, or anything you could measure easily.

This would be a journey to be more curious, to think smaller and to connect with people differently.

This is where it gets interesting. We started working with a consultant, but it seemed he was using a different language. When I said customers, he thought I meant Service Users. He called my customers partners, and the Service Users, well he referred to them as people who used services.

We’ve all realised we have to understand how our use of language affects people and the way we think about them.

I learned that language can create assumptions.

So, we agreed to improve our approach to working with people, to getting them more involved in how the business worked.

We have experience of running and being involved in surveys, consultations and Service User forums. But now we are going a few steps further and learning how to co-produce with people.

So, then I had to learn about the ladder of co-production, and how hard it is to climb.

We’re working with a number of organisations to help us get better and our experiences responding to the pandemic taught us a lot. But co-production? We’re not there yet.

In fact, it’s best not to think too much about it, just listen to people, be curious about their lives and always be open and honest with them.

I’ve learned that when the time comes, other people can tell us when we have co-produced something, in the meantime we won’t say it about ourselves. In a future blog I hope to be able to tell you all what difference this journey has made, to the people we support, their families, the communities they are part of and the other organisations that work with them.

For now, I’m learning the language of outcomes. That most elusive of concepts.

There's lots of help out there, and Adult Social Care, Health and Public Health have very clear outcomes frameworks and CECOPS are working on this. Most recent tenders reference them all, along with their own maintenance outcomes, improvement outcomes, outcomes for people, communities and systems.

But of course, people still want to know how much and how quickly.

We are engaging with and expecting to do some work with an organisation who have a background in community development. We’ve learned a lot just from talking to them.

They talked about the “meaningful moments” Medequip staff have with people who use the service and the phrase “smiles given for miles driven” popped into my head.

Now that’s my kind of language.

– David Griffiths, Managing Director

As a family-owned business operating since 1998, Medequip has worked through many policy changes in health and social care. Over this period we have always worked in partnership with contracting authorities, the people who use our services and the many organisations working to support them. 

The most recent paper on the subject (https://www.gov.uk/government/publications/working-together-to-improve-health-and-social-care-for-all) is hard to argue with. Who wouldn't support integration and innovation if it helps to improve health and care for all? 

But has this Government and the NHS learned the lessons of the previous NHS reorganisations? 

Is it simply a shuffling of responsibilities with only lip-service paid to the fundamental challenges facing our society and the behaviour change needed to address them? At Medequip we see those challenges every day. At Medequip we reflect on our behaviour every day. 

For example, does this policy and the impending legislation deal with the systemic issues that challenge true pooled budget arrangements? I know they are only one aspect of integration but we feel there is more that could be done.

Integrated Community Equipment Service budgets are a longstanding example of pooled budgets. The theory behind them is simple. It can be a fruitless exercise trying to work out whether it is the NHS budget or social care budget that should fund particular items of community equipment and even more complicated to establish which budget benefits in the long-term. So, much simpler to pool the budget, focus on outcomes and share the risks of an overspend. 

Even with these longstanding arrangements and history of partnership working, we are seeing increasing requests to separate out health and care spend. With years of underfunding the pressure had to come out somewhere. Budget pressures have damaged the trust between partners. 

We work with over 40 contracting authorities, countless public, private and voluntary sector providers and a whole warehouse full of different suppliers and manufacturers. Through this, we have learned one thing about true partnership working. It happens when people trust each other. When they take the time to understand each other's position, challenges and cultures. 

Then, and only then will we achieve more by working together than we do trying to address the challenges individually.

Without that trust, the system will grow layers and layers of bureaucracy, financial controls and governance. Not only between the partners, but between the organisations and the people we are here to serve and support. 

So, whilst commentators debate whether the policy does enough to address social care as the poor relation, the merits of "a duty to collaborate" and the technical challenge of having two parallel governance structures for Integrated Care Systems, we at Medequip would encourage policy makers to focus on supporting the behaviours that grow trust between organisations so that we can better earn the trust of the people we are here to serve. 

While that debate happens, we will continue to deliver, service and collect over 4 million items of equipment a year, to listen to and learn from the 1.3-million people we support each year, and work in partnership with those that trust us to provide public services on their behalf. 

If you would like to work in partnership with Medequip, why not contact me or one of my trusted team at david.griffiths@medequip-uk.com.