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Yet Another Project

30 Jan 2018 - 11:51 by Nigel Rose

Earlier today I read part of a new report by the King's Fund called ‘Re-imagining Community Services’. It analyses the progress made toward creating new models of community services and summarises some of the key principles that should guide the development. It’s illustrated by a number of case studies (some rather less convincing than others – Wigan as an exemplar of working with local assets – it doesn't even have an infrastructure provider since Wigan CVS collapsed a couple of years ago).

One of the key findings, that particularly rang true for me, was that there has been limited progress and what there has been is mostly projects rather than addressing the problems of existing services. People want to do the next new, exciting, "innovative" thing rather than sort out the seemingly intransigent long-standing problems.

One of the funding streams mentioned in the report that I saw in operation was "Better Care" funding, a kind of bridging funding between hospital and community. Throughout the city, this was used on "innovative" project funding. For example, a new team was set up to visit people at home and "optimise" their medication. Another, less positive way of describing this service was that it was set up to correct some of the poor prescribing decisions of other doctors.

The obvious question, that I asked, and I'm quite sure that a lot of you are already wondering, is what was being done about transforming the prescribing practices of the doctors who were making poor decisions. The answer was nothing, or at least nothing that was being measured or recorded. The targets were about the number of patients seen, not about improving the operation of existing services, even though this was the aim of "Better Care" funding.

Again and again I come across projects that are trying to fix problems by sticking something new on top. It's like mending a broken wall by cementing over the top of it. It'll make it seem better for a short time but it will always fail unless it's redone again and again. We need fewer new services, instead we need to make the ones we have work better. If people aren't communicating then sort out a way of communicating, if people are bogged down by bureaucracy and unnecessary data protection rules then sort it out, if doctors don't know how to optimise medication then teach them.

I suspect the Local Care Organisation (LCO) is another version of the sticking plaster, something on top, an expensive diversion, but perhaps it will be the vehicle that does address the day-to-day problems of making systems work, and it won't be diverted into new projects and questionable "innovation". It will only do this if it encourages people who work in services and who receive services to identify the problems that need fixing. The LCO's job then is to do the hard, often unexciting work of fixing those problems one by one. In reality, that's how the "world class services" they want will happen.


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