The process you use to get to the future is the future you get. 

A couple of weeks ago, Scottish Care launched its 5-year strategy, with a new strapline – ‘Social care that works for Scotland’. A shared ambition of many at a time when the opportunity to succeed presents us in the form of the National Care Service (NCS). 

With all my heart and soul driven by a 22-year career of blood sweat and tears in the sector from frontline to board room, I want it to succeed. I, alongside countless others, have felt the brunt of systemic failure by putting process ahead of people and know that to preserve our health, our humanity, our dignity and the contents of our pockets, it needs to succeed. 

The Independent Review of Adult Social Care heralded an opportunity to revolutionise the way that social care and support is commissioned, delivered and accessed. It set a direction for this complex living system to align itself to, with the Scottish Government at the wheel.  

Scottish Care received funding from Scottish Government to involve those 900 organisations who provide around 85% of care and support to contribute to the ethical commissioning component of the NCS (report imminent), yet it is over 2 years since anyone from the team at Scottish Government working on the NCS, has meaningfully met with the independent care sector on any other part of the programme.  

From discussion with other leaders in the system, we are not alone in this experience. Scotland is rich with theorists, system leaders and social care experts, yet all this seems to be set aside as we accumulate experience of unsatisfactory engagement sessions, no clear publication or involvement in the steering or governance process, and now a much-reduced Bill which has lost the original ethos of the IRASC.  

My back-of-a-napkin (because I don’t want to waste yet more time on this) mathematics suggests that those organisations contributing to the NCS by unpicking and trying to make sense of the morsels sent our way, have spent around 3000 hrs this week alone working on it. That’s 156,000 hours a year. If we had a clear and transparent process in place, that time could be reduced significantly, and used much more effectively. <It’s also worth noting that the calculation doesn’t even touch the time incurred by Scottish Government or the Health and Sport committee.> Imagine still that resource was diverted, and we delivered 156,000 hours of frontline care and support instead. Revolutionary indeed.  

The lack of an evidence-based approach to the development of the NCS has limited the opportunity for shared leadership and governance. Instead, the process has created confusion and division underpinned by a fight over where the power lies, and ironically missing that the redistribution of power is one of the main drivers of the NCS in the first place. It should of course ultimately lie with people accessing care and support.  

Living systems theorist Myron Rogers describes 6 maxims. The final one of which is that ‘the process you use to get to the future is the future you get’. Should this be true, we will inherent a system built upon naivety, waste, and bitterness. A far cry from the vision of the IRASC and perhaps the final nail in the coffin for our currently failing wider Scottish health and care system. 

So where do we go from here? Well, a good place to start would be to visit those 6 Maxim’s using them as guiding principles for the work to be undertaken.  

1. ‘People own what they help create’ – Shared ownership creates a shared responsibility. This is how we get collaboration into action. And where there is collaboration, there is a maximisation of resource and opportunity and a reduction in waste. 
2. ‘Real change happens in real work’ – we need to stop playing with engagement and start working on collaboration and co-design, not just of the NCS, but of the process we take to get there. 
3. ‘The people who do the work do the change’ – it has to be a shared process and that is going to take effort and resource to embed culture change 
4. ‘Connect the system to more of itself’ – YES YES YES! This is the only way we can deliver a seamless person-led experience of health and social care from cradle to grave. And guess what, it will also make better use of what we’ve got saving £££. 
5. ‘Start anywhere follow it everywhere’ – there is still time to get this right, but we need a coproduced plan as well as a coproduced vision. 
6. ‘The process you use to get to the future is the future you get’ – this is not a rehearsal; we need to apply methodology to the process and to the governance of the process. 

It’s high time that the continuous improvement methodology being placed into the NCS is applied to the process of designing, developing and leading the NCS. We need an acceptance that we can and must do better, and an immediate application of systems change theory into the NCS process. There is still opportunity for a seismic shift if we all get behind it, especially as Friday saw the deadline for consultation responses for stage 2 of the Bill. 

Only together can we make social care work for Scotland. Who’s with me? 

By  Karen Hedge

Deputy CEO, Scottish Care