The Connection Test

We’re pleased to have joined the Coalition for Collaborative Care which is attempting to embed models of collaborative care into the NHS. This blog is based on my recent blog for the C4CC.

Partly driven by the necessity of redefining what public services can do during austerity, a consensus is building that public services are not something that ‘professionals’ do to ‘patients’ or offer to ‘customers’, but are increasingly built on the success with which responsibility, knowledge, resources and – ultimately- power can be shared between people or families with long term support needs and workers who bring expertise, skills and kit, but who can’t magic up long term health and wellbeing for another person.

We’ve joined the C4CC because the need for collaborative care is a strong argument for collaboration between the NHS and the voluntary, community and social enterprise sector, of which we are a part.

Developing collaborative approaches is also a challenge to our sector: does every charity and social enterprise have the kind of close, trusting relationship with individuals and their communities that our sector claims? How do you maintain a strong connection with a community if you are a very large national charity for instance? Some national charities demonstrate that they can combine the clout of being big with the ethos of being localised, but good local relationships can’t be assumed, just because an organisation has a charity number.

It’s also important to understand that whilst collaborative models of care are a strength of charities, community groups and social enterprises, ensuring those models ‘get into the water supply’ (as Canadian social entrepreneur Vickie Cammack puts it) of public services can’t just be the role of our sector. We need a way of building the expectation of collaboration into every contract for every kind of service, whether public, private or not for profit, so that it becomes core business and embedded into all commissioning.

In the absence of a better term so far, I’m calling this expectation, ‘the connection test’ and it’s a test I believe should be universally applied across public service provision and commissioning. The test would be something like this:

Does this intervention or service leave each individual, family or community it is offered to:

• Better informed (or mired in jargon and bureaucracy)?
• More confident of their own capacity and more resilient (or more reliant on outside help and expertise)?
• Better connected to those around them (or with new barriers between them and their family, friends and neighbours)?

It’s easy to see how many charities directly try to achieve these goals, particularly where they are delivering community-based initiatives. Adopting these tests universally would help to drive resources towards such initiatives, because each test is harder to pass, the more institutionalised or industrialised a service becomes.

However, every intervention, and particularly every intervention which is intended to be long term, can pass or fail the test: it can be delivered in a way which is confusing, undermining and isolating, or in a way which shares knowledge, resources and power, which aims to minimise its negative impacts upon relationships and connections and where possible, to support those informal support networks. So, for instance, an intervention may be possible to deliver closer to home, rather than in a distant building, or a team working with an individual can make the choice to share formation and expertise with family carers and to be contactable in an emergency. In some cases, those kinds of choices may make a service cost more, but that cost needs to be set against the costs and benefits of sustaining the individual’s independence or a family’s ability to care.

The ‘customer service’ paradigm for public services is over. It looked achievable and affordable briefly during the boom years, but it can lead to unmet expectations and weaker civic society relationships, which hurt the whole concept of public service during austerity. Collaborative care is not a customer/provider relationship, it’s a much deeper connection in which responsibility and resources are shared.

If you do a great job of carrying out a procedure, or providing treatment, but you fail the connection test, your service is not giving itself the greatest possible chance of success – which means it’s also failing the value for money test. So ‘efficiencies’ which shave a few minutes off contact times, at the expense of people or families having the knowledge, networks and back-up they need to live well with a long term condition, are, in fact, inefficiencies. But if we think collaboratively, then every intervention becomes potentially a preventative intervention. That’s why it’s the key to a public service culture which we can afford, as well as one which feels like it’s on our side when we need it most.