Fundamental to the Fulfilling Lives program is a focus on system change. That is to say, changing the culture and the practices within the physical health, mental health, housing and criminal justice service delivery system to provide a more holistic and well-connected service user experience. The Big Lottery, the national organization that funded the 12 Fulfilling Lives programs across the country, mandated that every Fulfilling Lives program should include in their vision and business plan, a focus on better coordination of services between all sectors. The individual vision of the Fulfilling Lives program in Newcastle-Gateshead is:
We want to radically change the health, social care and criminal justice culture in Newcastle and Gateshead so that people with complex needs can make it from crisis to stability, getting a home, a job and sustained wellbeing. Concentrating on outcomes for people rather than organizations, services will be better joined-up, less risk averse and see people’s assets rather than their problems.
I spent time my first week here with several of the System Brokers who work with Fulfilling Lives. The Navigators, who are front line staff, report back to System Brokers. Navigators notice the system barriers as they work to help people connect to resources in the community. System Brokers are the next step in addressing those barriers, in part by keeping people updated and informed about the program’s goals and projects and by strengthening relationships with community partners. At a meeting with a local service provider with which there had been some tension around perceived referral rejection, I observed how the System Broker took a wide-angle look at the problem in a way that was very non blaming of the partner agency or any individual staff member. The system focus was epitomized in statements like, “We just need to trust one another – everyone is doing their best job,” and “The system is failing this person.”
System Brokers also develop relationships, provide information to and influence people who are in a position to change some of the rules governing things like housing. For example, there is a rule in the UK called Local Connection which means if you can’t prove your connection to an area, you aren’t eligible for what we in the US would call subsidized housing in that area; this rule disproportionately affects the homeless and people in recovery who may need to change areas to have a successful recovery. One of Fulfilling Lives system brokers has worked with local authority members who govern housing programs to consider a type of exception to the Local Connection rule for people with multiple, complex needs, similar to an exception that is granted for survivors of domestic violence.
Service users or Experts with lived experience are also extremely important to this idea of system change, for the obvious reason that they have firsthand knowledge of what is getting in the way of better service delivery. Fulfilling Lives has even trained Service User/Peers in the basics of how to conduct research. The Peer Researchers, with ongoing support from the Research and Evaluation team are then able to conduct the research that will help create a body of evidence to support the system changes identified by Navigators, Brokers and the Peers themselves.
Of course system change happens in the US as well; Coordinated Entry is a type of system change mandated by Housing and Urban Development (HUD) which requires that all Continuum of Care (CoC) funded housing programs work together to prioritize the most vulnerable people for housing. Currently, a subgroup of the CoC in Boise is working on a plan for Coordinated Entry locally. Another large scale system change operation is Idaho’s State Healthcare Innovation Plan or SHIP, a statewide effort to transform the healthcare system in Idaho.
There are several aspects to the focus on system change in Fulfilling Lives that stand out for me: it seems very much a part of everyone’s job description, the approach is very bottom-up, and there is staff development and organizational structures in place to facilitate it. As one community partner put it, “Fulfilling Lives is part of the system and charged with commenting on the system at the same time.” In some ways this could be seen to make things easier as there is a general awareness and buy-in within the local and larger healthcare system that facilitating change is part of Fulfilling Live’s role; on the other hand it can still be quite difficult because the U.K. Universal healthcare system has many layers to it and, as within any large system some people and organizations are more amenable to change than others.
For an outsider, coming from a different country with a different governmental structure and different ideas about healthcare systems, system change and advocacy, this system change focus within a service provider organization has me reflecting on systems and change within my own local context. It is like having another lens with which to view the familiar, giving me a new perspective … one that is still being mulled over and shaped the more I learn.