Innovating and Integration

I’ve been around the health and social care sector for a while — well, over 20 years of work anyway. Most of those years have clearly been within the ‘social care’ sector but latterly, I moved into the NHS and generally areas that have more of a ‘health’ focus.

However, I’ve been through many different ‘integration’ initiatives. What shocks me is how many people think ‘integration’ is still innovative. I guess if you define innovative as ‘we’ve been trying different projects of working together for over 20 years — let’s try a few more including repeating what was done 10 years ago’ then yes, it might be but that’s an incredibly dull definition that brings nothing new to the table.

We see language like ‘pioneer/vanguard etc’ all lovely positive phrases dreamt up by bright young things (or highly paid consultants) to sound positive and to make it seem like systems in health and social care (and housing and third sector) moving in the same direction and planning together strategically is something new. It isn’t new. Sorry to burst the bubble of the ‘vanguardistas’ or ‘change agents’ or whatever they are calling themselves.

Projects and pilots have been running for decades. I know because I’ve worked in some and there is interest and enthusiasm. They can work very well in local areas where there is potential to share budgets and staff — where people who work in different parts of the system are co-located and can see and work with people who are individuals and not just names on a telephone (or email list).

We need to ask more questions about the big changes that have been lacking. Yes, this micro projects and little local pilots can produce good results but why have none of those that have worked well been rolled out nationally — why are we still having the same conversations about integration that we were 10/15/20 years ago? Where is the learning from the pilots that have happened being collated, reviewed and published before deciding that another person wants to place their own ‘innovation’ credentials on display by starting another project.

Small scale, locally focused projects are not difficult to establish — especially if there is ringfenced money to follow them around. It is rolling this out into a sector and a system that the challenges come — when there isn’t additional ‘seeding’ money.

So by all means, innovate. I am all for innovation. But a desperate plea for innovation to actually mean more than working together and pooling budgets in very small, time limited pilots — because we know that can work. I’d like to see the evidence used to benefit the whole. I see a constant need to rework small pilots a way to avoid dealing with the larger issues and challenges to integration.

We know what the problems and bars are to integration. We also know, if we look at pilots of the last decades, what works. The real issue is making large scale change and my worry is the focus on ‘innovative pilots’ just provides an arena for further prevarication and procrastination. The ironic position that innovation is actually becoming a barrier to change.