Systems and their barriers

What this means

Unfortunately, there are current barriers within the health and social care systems. These barriers disempower people and get in the way of people ‘leading the lives we want to live’. Although it is technically separate, the welfare benefits system has become more restrictive and also has many barriers – this is important, not only in itself, but because it can affect eligibility elsewhere.

Some of these barriers seem directly caused by lack of resources, for instance, by not paying people for co-production. Some are about how organisations have evolved, with bureaucracy and fragmentation creating barriers – such as people being asked to continually repeat their stories – where none may have been intended. Disagreements about money between health and social care can directly affect people, because these lead to delays and make people feel they are being bounced between different panels and organisations.

An outcomes approach means just that - that outcomes are the focus, not for systems to get tangled up in talking to each other.

No-one means to put a barrier in your way, but it happens nonetheless.

The research

Person-centred practice is about focusing on a person’s outcomes - which is about the impact support or services have on a person’s life (Glendinning et al., 2006), rather than the means by which they’re delivered. True outcomes-focused practice moves towards greater integration of services, as it should matter less who pays for the services than the outcomes it delivers (Kelly et al., 2020). These issues are also explored in the More resources, better used key change section, particularly when thinking about waste and efficiency, and transitions.

However, in a study looking at how the success (or otherwise) of health/social care was measured, Kelly et al. (2020) found ‘…despite the drive for integration to provide person-centred and tailored care to benefit the patient, the measurement of patient and carer outcomes were identified slightly less frequently than system outcomes or process measures.’ This indicates that who defines or evaluates a successful integration is not always the people who will feel its impact (Kelly et al., 2020).

Increased co-production is as important when thinking about how to tackle issues arising through poor integration, as it is when identifying and addressing barriers. There’s also more information about this in the More resources, better used key change section – particularly within the passage on accountability.

The Disability Benefits Consortium (2019) has calculated that disabled people lost, on average, £1200 per year, every year, in the years since 2008. The more impairments a person has, the more money they lost. The lost money was due to several cuts working in tandem - including benefit freezes, benefit caps, removal of disability premiums, and the introduction of universal credit. The experiences of assessment for work capability and for Personal Independence Payment were sometimes highly stressful, and had an adverse impact on wellbeing regardless of whether the assessment resulted in the required level of support (Hudson-Sharp et al., 2018).

In addition, White (2016) found that welfare benefits changes had a negative effect on the social care workforce, too - increasing demand for services generally, and specifically on the proportion of professional time spent reassuring people affected by welfare benefits changes, and guiding them through the system. Workers were emotionally distressed, frustrated and angry at how the lives of people they worked with were affected (White, 2016).

What you can do

If you are in direct practice: The research suggests that navigating the welfare benefits system, and health and social care systems, is often difficult for people (see, also, the section on Communication and confidence). It is really important for you to be an ally in doing this, while acknowledging your own possible feelings of frustration and distress. (On that final point, you may find it helpful to think about issues around emotional resilience for adult social care professionals, and the support you should be able to draw on from your own organisation.)

What are some of the steps people can take to help people to navigate the system?

In this video, Jenny Hurst shares tips about supporting people to navigate the system.

Local advice and advocacy services may also be able to offer direct help to people, but much of the signposting and emotional support work will likely still rest with you. You may be the only person who someone can contact directly. What support do you need in helping people? What extra knowledge would be helpful? It may be useful to analyse, as a team, what system-related queries come up repeatedly and devise a team strategy for helping people through them.

If you are a senior leader: Pro-active work to join up health and social care is also covered within More resources, better used. A key, evidence-based way in which you can contribute to joining up services, so people with care and support needs experience fewer fragmented and delayed responses, is to practice systems leadership alongside co-production.

For an example of systems leadership, consider Local Area Co-ordination in Thurrock. Senior managers from adult social care deliberately and proactively engaged with other senior leaders in housing, mental health, fire and rescue, public health, and the police. This led to the creation of Local Area Co-ordinators (LACs). LACs don’t provide a formal health or social care service – instead, they ask the question 'What would make a good life for you?'

Read more about Thurrock's LACs, with examples of help offered.

Further information

Explore

Citizens Advice has comprehensive information on the full range of welfare benefits in the UK.

Tool

MyCommunity has a tool designed to help with mapping assets in your local area.

Read

A briefing on Systems leadership – enhancing the role of social care from Research in Practice.

Explore

There is a suite of resources on outcomes-focused practice from Research in Practice, including dedicated resources for managers.