A particular paradigm: We have a system designed for that...

Featured article - 19 January 2021
By Deborah Travers, Adult Social Care Change Manager at the London Borough of Bexley and Vikki Wilkinson, Chief Executive of Bexley Voluntary Service Council

Head-shot of the author, Deborah Travers, Adult Social Care Change Manager at the London Borough of Bexley and Vikki Wilkinson, Chief Executive of Bexley Voluntary Service Council

Service transformation, innovation, partnership and collaboration. So many exciting words to implement change. We proclaim a focus on improving the quality of life for local people but choose to define ‘quality’ in ways that don’t necessarily relate to people.

We strive to commission services that are good value, efficient, effective, safe, but is that what is really important?

Where is the true value?

Perhaps it’s your pharmacist delivering your pain medication. Or your befriender dropping in to deliver your medication and staying for cake and a chat while you celebrate your 89th birthday?

Which of these ‘interventions’ will lead to positive and lasting impacts to your health and wellbeing? As health and care systems, we value professionalism, training, technical knowledge, authority, credibility and status. When developing organisational structures, contracts and partnerships we see the power and control given to those with the highest status in these areas.

Maximising the ‘value’ of the community sector

But what about the community and voluntary sector whose value comes from what is often invisible; relationships, local knowledge, trust, reciprocity, small acts of kindness, empathy? We recognise the value of the sector but develop contracts built on visible performance, cost and our perception of quality. By maximising the ‘value’ of the community sector, we stand at risk of eroding the core essence of the sector. Until the system values the importance of community, togetherness and trust the system will not fundamentally change, just replicate existing systems and power structures.

Within the London Borough of Bexley we have commissioned a consortium of local voluntary sector organisations to complete Care Act assessments on behalf of the Adult Social Care department. This contract (co-designed with partners) utilises the relationships local organisations already have with local people. Responsive decision making about care and support is made by someone who knows the person, their support network and social capital.

Contracting services (based on relationships) within the current system of competitive procurement is stimulating, challenging, thought provoking and an absolute nightmare. Have you ever tried to evidence the value of your personal relationships through Key Performance Indicators, cost analysis, quality monitoring and the open market (Maybe this is a new dating app we could develop!)? Local authorities are accountable to ensure the value and quality of services provided. But measuring and costing their impact and the social value of prevention is not a formula when we are talking about people, their passions, diversity and individuality.

We need to revisit our shared perception of ‘value’; of what really matters to our local communities and residents and what really improves people’s lives.

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