Routes for social and health care: A simulation exercise

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The health and social care system is currently tackling three inter-related challenges: coping with rising demand and reduced funding; handling NHS restructuring; and transforming social care. How can these challenges be seen as an opportunity to achieve fundamental change to the system?

The Routes project, a simulation exercise created by Loop2, allowed senior managers and thought leaders from across the NHS, local government and the third sector to test out a remodelling of the health and social care system in a safe learning environment.

Routes for social and health care: A simulation exercise focuses on Crafton – a hypothetical metropolitan borough in central England – and sets up a number of routes to managing change. During the simulation two contrasting viewpoints emerged.

One group took a strongly managerial perspective that recognised the need for immediate decisions to reduce expenditure, while putting in place the conditions for a radical transformation in the way that people receive care and support in the longer term.

The other group took a more 'devolutionist' approach, arguing that the financial challenges across health, social care and housing could not be managed through a top-down approach; they proposed a radical acceleration of personalisation and community engagement.

Participants in the simulation built on the insights they gained to identify strategic routes that might be followed to achieve change on the scale required.

The Routes project was commissioned by The King's Fund in partnership with the Joseph Rowntree Foundation, the Social Care Institute for Excellence, the Association of Directors of Adult Social Services and the Local Government Association.

The publication offers some important reflections for policy-makers, commissioner and providers, including:

  • the challenge of moving beyond short-term efficiency savings to longer-term transformational design of services
  • the tension between top-down managerially led approaches to change and a more devolved outlook that stresses individual control and choice
  • the potential of health and wellbeing boards to offer system leadership in moving towards different models of care.


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