For over a year now, hundreds of different providers of health and other public service providers have been working hard to create new models of care in their local vanguards.

Most of these providers, who are working to wrap very different services around the public’s needs, have come across two very different experiences. The first is that they know this is important both for the public and for the future of public service to create person centred coordinated care, and the second is that this is very hard.

For over 60 years the providers of health and social care services have been characterised by specific sets of service offers which taken as a whole has developed into a very fragmented public experience. For very good reasons in 1948, Nye Bevan created a small private business model for GP services and a nationalised public service organisation for hospitals. The historical specialisation between hospitals of mental health and physical health become entrenched, and for over 60 years community health services have been bounced around between different relationships.

In further contrast, 1948 saw social care embedded in local government where from the 1980s onwards nearly all public provision has been taken by the private and voluntary organisations with an entrenched rupture between care and home and residential care.

Over the 60 years we have ensured that each of these very different organisations have become more and more accountable for the specific care that they provide.

Most of the people who work in these organisations are passionate about the care that they provide. Whilst this passion is essential, on many occasions it is expressed around the very specific aspects of care that they themselves provide. If you really care about what you do then being a district nurse is very different from being a health visitor that is very different from being a diabetologist or a domiciliary care worker.

Accountability and passion are two very important parts of serving the public.

You can often smuggle change into an organisation by pretending it’s really what we have been doing all along but what the vanguards have shown is that it would be wrong to underestimate the scale of the change that they are involved in.

But…

The problem for a person using services, let’s call her Mrs Jones, is that she experiences all of these passionate staff as an often bewildering range of very different interventions; with different organisations and very different cultures.

This is why the development of new models of care by the vanguard providers is both so very important and so very hard.

Intellectually the case for person centred care has been well made. But the challenge that this intellectual agreement raises for the way in which we deliver services is at the heart of what the new care models ask of organisations and staff.

You can often smuggle change into an organisation by pretending it’s really what we have been doing all along, but what the vanguards have shown is that it would be wrong to underestimate the scale of the change that they are involved in.

Take one example of an outcome identified by the vanguards that is there for nearly every older person they work with. We, older people, (I’m 67) would all hope that whenever we use a health or other public service our lives would be more independent at the end of that experience than before. Intellectually that is very hard to argue against. But practically, if you walk through how most of our services actually work with older people, nearly every interaction creates greater dependence not greater independence.

Changing all those practices to create a pathway of very different services that leaves me more independent at each step is very hard indeed.

And that is what providers in the vanguards are working towards. Very important work and very hard work.

Biography:

Professor Paul Corrigan gained his first degree in social policy from the LSE in 1969, his PhD at Durham in 1974. He is currently adjunct professor of public health at the Chinese University of Hong Kong and of health policy at Imperial College London.

For the first 12 years of his working life he taught at Warwick University and the Polytechnic of North London. During this period he taught, researched and wrote about inner city social policy and community development. In 1985 he left academic life and became a senior manager in London local government and in 1997 he started to work as a public services management consultant. In 1998 he published Shakespeare on Management.

From July 2001 he worked as a special adviser to Alan Milburn first and then John Reid, the then Secretary of States for Health. At the end of 2005 he became the senior health policy adviser to the Prime Minister Tony Blair. Over these six years he was instrumental in developing all the major themes of NHS reform not only in terms of policy levers buy also in developing capacity throughout the NHS to use those levers.

Between June 2007 and March 2009 he was the director of strategy and commissioning at the London Strategic Health Authority.

Since then Paul has been working as a management consultant and an executive coach helping leaders within the NHS and internationally create and develop step changes within their organisation. In September 2011 he published a pamphlet “The hospital is dead Long live the Hospital” that was recognised by a leader in the Times as an important contribution to reform. He continues to argue the case for NHS reform. From July 2013 he has become a non-executive director of the Care Quality Commission. In 2015 he is working with NHS England to help them develop the new models of care.