Deep thinking: health and social care

‘You’ve got the job, well done!’ With one brief phone call, I found myself appointed as a chief officer for health and social care integration. Having studied integrated public services in Denmark a few years earlier, the opportunity to lead one of Scotland’s new heath and social care partnerships was a natural progression from being an allied health professions director. 

 

Two years on, the health and social care partnership is responsible for planning and delivering a wide range of community and hospital services. With a budget of £180 million, the partnership serves 150,000 people in an area of 2,000 square miles.

 

Though integrated working is not uncommon in the UK, Scottish legislation provides a firm framework. Now, after much planning, health and care services are really beginning to change and our focus is turning to patient-centred outcomes.

 

Colleagues often ask what integration means in practice. Will their specialist skills be lost with the greater emphasis on prevention and early intervention? How should they address inequalities and prepare for the deliberate shift away from hospitals towards community-based services? 

 

When doing research in Edinburgh, I became interested in the work of Andrew Sobel, a US-based strategy adviser and author. He suggests that ‘specialists” do better than ‘generalists’ but that ‘deep generalists’ do even better. Adapting Sobel’s four main principles to health and care, deep generalists never lose their specialist skills and they are keen to learn the skills of others while being willing to share their own. They line up their priorities with the needs of the population and the goals of their organisation. Finally, they do not take themselves too seriously, or, as we say in Scotland, they are not ‘precious’. 

 

In short, deep generalists are innovative, focused, flexible and adaptable. At a time when we are expecting the available workforce to reduce, it is unlikely we will be able to sustain current models of practice. We are going to see a 70 per cent increase in people aged over 85, whose needs will be more complex. 

 

Would a deliberate shift towards prevention, anticipation and early intervention be helpful in preparing the profession for the coming change? Successful systems plan ahead: they emphasise safety, quality, effectiveness and value for money. Health and social care partnerships in Scotland, and sustainability and transformation plans in England, recognise the importance of working with people and carers, communities, the third sector, independent contractors and private care providers. Professionals and providers become partners with citizens in co-design and delivery. As Stephen R Covey, who writes about effective people, says: ‘Interdependency is the highest state of maturity.’

 

Physiotherapists are experts in transformation and possess many of the skills to lead the change that is coming fast. In explaining my job, I often say I am delighted to have a real opportunity to lead and reshape health and care. So I ask you, as my former professional colleagues: are you ready? After all, we will become consumers of the care we design.