Shifting Care Closer to Home – tensions and entanglements

If you’ve been reading previous One Minute Reads or are reading this in some snatched time between meetings, you will be very familiar with ‘Shifting care’ from hospital to community and home settings as a mantra in contemporary health and care policy.

Investing more heavily in out of hospital services and support for people at home and in their local communities is heralded as fundamental to enabling ‘prevention’ and a range of other benefits as my colleague Alastair highlighted in his most recent One Minute Read.

Neither prevention or care closer to home are new concepts in health policy and have formed part of policy direction over the last 30+ years. Yet…this holy grail in health policy seems so difficult to realise

So, what might be important to pay attention to when seeking to assist this shift.

As a former health service manager and clinical leader, I can count the times I sat in meetings discussing prevention and noticing that we were circling around different definitions. What do we mean by prevention and what are we preventing are useful starting questions in any collaborative effort to imagine a different shape to how needs are met.

When we foreground or privilege a range of needs, we run the risk of pushing others’ needs to the edge or the background – yet they still remain in play.

What needs do traditional professional groups have that enable them to be fit for practice and for the future? What are the needs for new roles and emerging disciplines enabling the reshaping and re-invention of health and care?

The needs to demonstrate accountability – to who and for what? The budget? Outcomes?

The need for your local identity (as a practitioner, volunteer or organisation) in your own right, as well as being a partner in a bigger collaborative endeavour?

The need for certainty and control and how this influences leader and manager practices and service design?

The need to look like we know the answer – even though behind what looks like a robust professional exterior, there are feelings of worry, frustration, notions of ‘where do I start?’, that are hard to express as we expect colleagues to navigate the complexity

The rush and hurry to ‘do’ and the admission that we don’t get enough time to THINK?

Whilst the above is far from an exhaustive list of needs that are manifest in our NHS and care system today – I experienced them, and I continue to notice them as real tensions – often showing up as paradoxes.

The need for a health and care system that enables safe, effective and personalised care, where people matter is once again the subject of reform. Easy to say, complex and dynamic in nature to make a difference in.