A few weeks ago I visited a GP surgery with a family member to discuss a few issues that had been bothering them. They were told – with no uncertainty – that they shouldn’t attempt to discuss more than one issue per appointment as they were limited to 10 minutes. It was stated that there was “no way anyone can deal with more than a single issue” within that time frame.
A letter in the British Journal of General Practice back in 2015 discusses the limitations of the 10 minute appointment. “When a patient’s problem(s) are not able to be safely and effectively dealt with in a 10-minute appointment there are only three possible outcomes: the problems are not adequately dealt with, they are dealt with but take longer than 10 minutes, or the patient is asked to make a further appointment.”
Indeed, as John Seddon has pointed out: ‘The effect of the rationing system is to make those in need keep presenting (creating demand that is not going to be satisfied) until their problem becomes serious enough.’
Watching the GP at work I was reminded of the chapter in Radical Help where Hilary Cottam shadows Ryan, a recently qualified social worker, and observes that 74% of his time is spent on administration and recording and only 14% of the time with families he is meant to be supporting. She describes the question and answer session with one of his clients as being more like a ‘tetchy interview’ than a conversation.
You don’t have to be a service designer to be able to observe when a system that was set up to serve the end user has flipped and is now in service to the system itself.
Last week a few colleagues and I had to the opportunity to speak to a number of NHS leaders about Bromford neighbourhood coaching. The model focuses on spending time in the community, building connections through conversation, and has ‘caseloads’ about 70% smaller than the industry average.
I recounted that when I started working in housing you had one community visit day each week and the rest of the time (80%) was spent on office administration. Your ‘visit days’ were purely reactive , responding to things that had gone wrong during the other four days. I remember serving six notice of seeking possessions (effectively a threat to remove someone from their home) on a Friday afternoon, leaving some poor folk worrying all weekend with no way of contacting anyone.
The system had taken over from the original organisational purpose.
During the NHS session two of our coaches, Amy and Sinead, told powerful stories about what individuals and communities had achieved when relational approaches had been used that start – not with a 10 minute appointment or a form being filled in – but with a conversation. Rather than adding things (specialist teams, additional budgets, new policies, more ‘professionals’) they talked of fostering community connections, bringing people together to solve problems and empowering individuals to do things for themselves rather than being done to.
Amy told us of a resident who had been a tenant for over 30 years but had never been spoken to by their landlord in anything other than transactional terms. Through a conversation about her interests she was now running a community gardening club and looking after neighbours pets whilst they were in hospital. Sinead told us about bringing together a group of young mothers who individually had been dependent on antidepressants but when brought together collectively to plan community events and support each other had been able to move on from prescription medication.
Rather than just performing the transactional role of a professional they were both strengthening the core elements that make up a community.
It’s not easy to change people’s mindsets from doing to connecting. It’s not easy to remove the scripts, policies and rules we have built around our institutions that suffocate creativity. It means investing in people and giving them the space to think and act differently. It means giving people permission to challenge preconceived practices and ‘rules’.
The social sector cries about being overwhelmed by demand but it is an entirely self created problem. Our services focus on needs rather than strengths, and as a result we have fostered dependency which in turn leads to increased demand.
Enlightened organizations know that people focused services build on existing strengths and promote responsibility instead.
The biggest problems we have across the social sector will not be solved by pouring more money on them. We need to rebuild the sector using the power of conversation and relationships. And you can’t do that in 10 minutes.
Related: How To Make A Paradigm Shift