People @ The Heart
Gateshead Multiple and Complex Needs Transformation Initiative
Today we share a report developed by the Collective Impact Agency, Goodlabs, Helmepark and Oasis Community Housing. This report articulates the findings of our work uncovering the disturbing reality of the system intended to support people with multiple and complex needs in Gateshead. We envision a better and healthier system, which places those individuals at its heart.
First, a bit of background - we were brought on board by the Gateshead Health and Care System Board, who had identified serious problems with how people with multiple and complex needs were supported by the borough. Professionals working with them often didn’t know of other groups that existed, and therefore didn’t communicate. This meant that the same individuals could have their situations discussed in multiple contexts, sometimes, we were told, with contradictory action plans being agreed.
The primary finding of this piece of work can be summed up fairly simply. You can either structure support systems around people or around professional concerns. Any system not structured around the people it is intended to serve is inevitably going to clash with and exacerbate people’s needs. Our current system is structured around professional concerns.
If you need any convincing, these quotes from the interviews we conducted with people across the system show a stark reality:
“I got to the point where I felt I had to harm myself to be considered for support from the NHS.”
“My GP would refer me to services but the services would write back to say they couldn’t help.”
“I had to fight for support from a service to keep helping me when I had a relapse recently. It feels like I was being punished for having a relapse rather than being empathetic and supportive at a point in time when I needed it most.”
“Having to tell my story over and over again is painful. It’s like ripping off a plaster every time, it hurts and the wound takes longer to heal.”
“There’s a guy I used to see who kept coming to A&E. He’d commit small acts of self-harm, so he could ask for bandages and get some support from doctors and nurses.”
“I got a call asking if I wanted to set up an appointment. I told them that I was too terrified to leave the house. Yes, I wanted help, yes, I needed help, but I just couldn’t commit to an appointment because my life was too chaotic.”
“On those days when you feel more in control of your life, it would be nice to be involved in those discussions. The meetings seem to be confidential, but at the end of the day it is about you. Plans get organised for you without your input, but at the end of the day it is the person that knows themselves best and what they require to turn the life around.”
The professionals involved are not to blame – it’s the way the system is set up that causes these unintentional harms, and it’s the system that needs rebuilding. And it’s important to say here, Gateshead is no exception – we hear the same findings across many different localities and contexts.
The recommendations we’ve proposed are as follows:
Our primary recommendation: “People @ The Heart” – the Gateshead system commits to doing what is necessary to transform itself into a system that is structured around people.
Use signals to guide proactive outreach
Invest heavily in iterative learning to drive system improvements
Empower and support the workforce
These recommendations are underpinned by 12 guiding principles, and 12 practices or behaviours needed to see these priorities through.
We can, and should, do better. Within this report, we try to describe what a better, healthier system would look and feel like, that is, a system working well both for those it serves, and for those working in it and with it.
You can download the full report here.