Community voices empower choice in health and social care

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The look on Robert’s* face told me he wasn’t impressed.

I’d called a public forum for the London Borough of Harrow. I wanted to talk through a brilliant idea. It’s my job to help Borough residents find the social care services and healthcare they need. For residents with the most needs, the search for care can turn into a quest. So, we had an idea about a cognitive health system that could show people personalised choices. And I’d called the forum for input.

As I began speaking and looked round the room, Robert’s stern face caught my eye.

Robert had worked as a fisherman all of his life, and now he was 80 years old. He’s full of fish tales and stormy opinions. And he doesn’t mind me using his story—he insisted that I do. Sadly, Parkinson’s disease and diabetes now force Robert to seek regular medical care.

A stormy opinion

When I started to tell the forum about the details behind our idea, Robert spoke up.

“No, that’s rubbish, this ‘personalisation’,” he said.

“It’s not real choice,” he added. “I have home care because I have to have someone to help me up in the morning. And you’ve got so many people in Harrow using home care, they come and they get me up at 6:30 in the morning. Would you like to get up at 6:30 in the morning, Bernie, and have your breakfast? It’s outrageous!

“And what’s worse is I have to go to bed at quarter to seven because that’s the way the system is set up. Tell me how many people here would want to go to bed at quarter to seven?”

I shook my head. No, I wouldn’t like that.

“And when I talk to my doctor, they don’t care about ‘choice’ and ‘empowerment’… It’s about saving my life! You’re not talking the same language!”

The community’s voice

I assured Robert that we understood, which we did, and that we heard his concerns, which we did. In fact, the Harrow Council formed a group of residents to help us test and revise the new cognitive system. We put Robert in the group.

We completed the system in 2015, giving residents a tool to plan both their budgets and their services. Robert, for instance, cancelled his rotating team of in-home nurses because he saw that he could use his budget to hire one healthcare assistant—a young fellow who’s gotten to know him. And rather than go to the day centre Robert didn’t like, his assistant can now take him fishing.

The power of choice

Last year, I happened to meet Robert’s doctor. He asked me, “What’s happened with Robert? We’ve noticed he’s not in the hospital as much. It seems he’s really actually enjoying life. He’s like a different man.” The doctor said Robert used to be in the hospital once every couple of months, often from not taking care of himself. The visits were costly, but they could never get to the root of the problem—Robert was just fed up.

But after our new system was done, I also spoke to Robert. What he said has stuck with me…

“I really thought, Bernie, when I got to 75, 80, my life would finish,” he said. “I thought ‘Well, what’s living worth, you know? What am I living for? I’m not doing anything. I don’t like to go to places. I don’t like having to get up and someone to help me.’ But, I really feel like I want to live now.”

People can’t make healthy choices until they have choices. That’s what I’ve seen. Our new system is built upon IBM Watson Care Manager. But I’m not going to tell you that this is a story about the power of IBM, or about the power of Watson.

This is about the power of choice.


Read the London Borough of Harrow Council case study

*Name changed to preserve anonymity.

**Image features model to preserve anonymity.

Director of Adult Social Services, Harrow London Borough Council

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