Re-wiring the State: What could this mean for social care?

For me, the most interesting question isn't who holds the power. It's whether we can finally create public services that work around people, rather than expecting people to work around public services. In my view, beneath the headlines about devolution and economic growth sits something potentially much more profound: a shift away from services designed around organisations and towards services designed around people, place and community. 

If that sounds familiar, it's because many local authorities, NHS partners and providers have already been trying to do exactly this for years. Some of the most progressive places in the country have been quietly breaking down silos, investing in prevention and asking the deceptively simple and obvious question: What happens if we start with the person rather than the service?

Do you live in a neat box? I don't….!

One of the biggest frustrations in social care is that people's lives don't fit neatly into organisational structures. Someone might need support with housing, mental health, physical health, social isolation, employment and care needs all at once. Yet our systems too often respond by sending them from team to team, service to service and organisation to organisation.

As people, we experience one life, but the system experiences six separate problems.

The Government's reforms appear to recognise this reality, with a greater focus on aligning local public services around places and communities, rather than maintaining organisational boundaries. 

Oh the magic that can be created if we start with relationships?

The good news is that we don't need to imagine what good looks like! There are already places showing us.

One of the most fascinating examples comes from Gateshead and Changing Futures Northumbria through what is known as the Liberated Method. Rather than organising support around referrals, thresholds and service criteria, the approach begins with relationships, trust and what matters to the person. It sounds almost too obvious – right?

The philosophy is simple: people experiencing homelessness, addiction, poor mental health or social exclusion don't experience those things separately. They experience them as part of one complicated life. Public services therefore need to respond to the whole person rather than to individual issues. 

And that brings me back to Brian, who I mentioned earlier.

So let's meet Brian….

Brian had more than 3,000 interactions with public services over a 14-year period. Think about that for a moment. Mind boggles, doesn't it?!

He came into contact with health services, criminal justice agencies and countless interventions. Large sums of public money were spent. Professionals worked hard. Systems did what they were designed to do. And yet Brian remained trapped in crisis.  What eventually changed him wasn't a shiny new service, a new performance framework. It was a relationship!

Through trust, consistency and people sticking alongside him, Brian began rebuilding his life. He secured accommodation, entered recovery and significantly reduced his reliance on emergency services. 

I find stories like this inspiring but also really frustrating. Inspiring because they show what is possible, but frustrating because we still talk about them as exceptional. They should be the norm. Why do we continue to celebrate examples of relational practice as innovation when the evidence repeatedly tells us they work? 

And, as a lawyer, can I end by dispelling a few myths….

As a lawyer, I cant tell you how much I hear that regulation is the barrier, that governance is the barrier, that procurement is the barrier, that GDPR is the barrier. It drives me crazy, which is probably why my work spans across public services as I have always seen how inter-connected they are. 

As many of you know, I see myself as a creative lawyer. My instinct is not to find reasons why something can't be done. It's to help organisations find ways to do it safely, confidently and legally. And the most innovative organisations we work with don't see law as a barrier. They see it as an enabler – just like us.

They use legal frameworks to build partnerships, create shared governance arrangements, redesign commissioning models and support collaboration across traditional organisational boundaries. So this is my very cheesy legal mantra as to how I do “the law":

Some of the best transformation programmes I've seen haven't succeeded because they ignored regulation. They succeeded because they understood how to use it intelligently.

So what's the real test?

The real test of Rewiring the State isn't whether new governance structures are created. It isn't whether more powers move from Whitehall to local leaders. And it certainly isn't whether organisational charts look different in five years' time. The real test is whether people experience something different.

Begin with purpose, the reason why….the dream of helping people fly……