How Can We Move From Demand Led Service In The ‘New Normal’?

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In the early hours of Good Friday I found myself undergoing emergency surgery after a complication during an earlier test. Even in the midst of some pretty intense pain I was unwilling to go to hospital — a mixture of fear of contracting a certain virus and some overly optimistic thinking about my super human ability to recover without any professional intervention. It was probably Karen wilfully ignoring my instructions not to call an ambulance that saved my life.

Eleven days later I was discharged from hospital after major surgery and two COVID-19 tests. Family and friends were unable to visit so I had a lot of time for self reflection, and to observe from the inside how systems operate during periods of genuine crisis.

The term crisis is overused. Every day the news is filled with stories about war, terrorism, crime, pollution, inequality, and oppression. There’s a health crisis, a housing crisis, a climate crisis , and a social care crisis. So many “crises” they have to jockey for position in order of seriousness.

What the COVID-19 crisis has done very effectively is to say “hold my beer” to the others — becoming the defining crisis of the moment.

One of the most interesting things about my experience of hospital was the apparent disconnect between the media reporting of what was happening on many wards, and my own actual experience.

Family expressed concern for the health workers without PPE at the same time as staff told me there wasn’t a problem. People told me the system was in meltdown when my observation was of staff continually adapting to new working practices based upon the evidence and experience of the previous day. Even if the system was in ‘crisis’, at a local ward level people were pulling together and solving problems in new ways. Freed of some of the usual ‘rules’ people were succeeding despite the system rather than because of it.

The NHS is brilliant at coping with an emergency , both at scale and at the individual human level. I simply couldn’t fault my experience, from the operation to the recovery to the after care. The people ARE heroes. It’s not the time to pick fault with the system , but where it often falls down is in some of the basics. These are often things that are less urgent to professionals , but more important to us as citizens , such as communication and keeping us informed of progress.

This is not limited to the NHS , far from it. It’s a symptom of systems that are designed to be reactive rather than pre-emptive. They tend to be designed from a ‘service’ point of view — managing demand — rather than through person centred design, the principles of which are the opposite of service led design.

During my stay, staff noted how demand had dropped. People simply weren’t coming to Accident and Emergency anymore. The country had either stopped having heart attacks and strokes or were delaying reporting them. This drop in demand isn’t limited to the NHS. Other social providers are seeing similar trends. The phenomenon has also occurred across the US and in parts of Asia.

So why has the system been able to manage demand, something that’s been a problem for decades, in just a matter of weeks?

Obviously , fear is playing a part. In a lockdown scenario people’s priorities have a major shift. Things that would once be major causes of anxiety get reordered in the face of a common enemy.

That said , there is something to learn from how the latent and underused power of community has been leveraged to protect our most precious resources.

People have begun supporting and caring for one another to an unprecedented extent, with community led groups popping up to address immediate needs in ways our organisations simply can’t. It is neighbours that have shown themselves to be the most useful support network in a physically distanced world.

YouGov have reported that only 9% of Britons want to return to life as normal after the end of the lockdown. 40% of people say they feel a stronger sense of community since the virus shut down normal life, while 39% said they had been more in touch with friends and family.

What this seems to indicate is that far from communities resenting a shift away from a passive provider-consumer relationship — they actually desire it. They want a greater say, they want more power to influence local decisions.

There’s a danger here of being overly optimistic as Simon Parker has warned. “Simply willing a better world is not enough. You have to dive into the complexity, dance with the system in its full, messy intractability”.

System change never comes easy. It means thinking beyond individual sectors and requires the whole system to work together, through health, housing, employment and social care. There’s opportunity here if we are brave enough.

That said , a lesson so far from COVID-19 is that the best currency for change is local. People are discovering their neighbours for the first time, spending less time travelling to soulless business parks , and spending time and money where they live.

Powerful forces will resist any attempt to make this a new normal. It’s not how capitalism works.

However my recent experience has led me to believe that the organisations that emerge stronger from this crisis will be ones who have abandoned doing things to people, and moved to seeing themselves as equal partners with communities.

That requires making a move from telling to listening.

A move from obsessively managing demand to leveraging the skills in the community.

A move from filling the gaps with more services to closing the gaps through social connections.

Originally published at http://paulitaylor.com on May 1, 2020.

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