Over the past few months I have been working with patients, carers and people who use services across North West London (NWL) to co-design “Embedding Partnerships” - a co-production workstream that sits at the heart of the NWL Whole Systems Integrated Care programme. Safe to say, I have learned a great deal in a short amount of time and my eyes have been truly opened as to how much there is still to learn before we get this new way of working right! One thing that has struck me is the paramount importance of working outside of our current paradigm in order to make the shift to a whole system that encompasses the people as well as the physical, legal and contractual constructs of health and social care.
I discussed how this might be possible with Paul Corrigan back in the summer: in his opinion, the singularly most effective measure to ensure that we are working in this way is to actively disrupt existing practice and set-up in a real and problematic way. This cannot be done as a tick-box, business strengthening exercise. Real disruption will force creation in the right strategic direction for a whole system approach with people at the heart: if the system is not dismantled then neither the act nor output of creation will be radical. The legacy of old ways of working will continue to hold grip onto the new design if that is where the change is born. In order for the change to a whole system to be successful, the current system will need to relinquish control and be taken on a journey.
The concept of destructive creationism might be a frightening one, and organisations will need to get used to this idea by practicing true disruption, learning to respond positively to this and understanding new ways to measure positive impact. The process of building together, with those that have traditionally been outside the boundaries of being able to do so also sharing the lead in a reciprocal balance of power, is fundamental to creating the necessary foundations and culture that will enable people to work together and the transformation of public services to be a success.
Alice Hopkinson is a senior consultant at PPL and project manager on the Integrating Care consulting team
To find out more about the North West London value case visit http://www.local.gov.uk/health/-/journal_content/56/10180/4060433?_56_INSTANCE_0000_templateId=ARTICLE