Why systems thinking may be the perfect complement to an ambitious 10 Year Health Plan

Making integrated care a reality

Attending a King’s Fund summit on integrated care recently, I found a broad consensus that reform was both welcome and necessary. Speakers from within and outside of the NHS agreed that shifting the burden from hospitals to communities – a central part of the 10 Year Health Plan – would relieve bottlenecks, aid prevention and deliver inclusive, patient-focused services.  

Yet there was equal consensus that the goal was ambitious and the road ahead a challenge, because our health service is the most complex of complex systems. That’s why systems thinking as an approach has so much to offer. 

Explaining systems thinking

User-centred systems thinking can reveal the path to better outcomes even when the number of inputs is overwhelming. What we refer to as ‘the NHS’ is in fact hundreds of organisations, all with different cultures, ways of working and tech platforms, creating gaps, overlaps and disconnects for patients and clinicians daily. Accepting, and working to solve those issues, must be the start of any sustainable fix.  

As a service designer who’s worked in and with the NHS, I need to understand how users interact with services and how those services interact with each other. Using systems thinking, we appreciate the fine detail of how services work for users, but then zoom out beyond the limits of any individual service. We map connections, dependencies and relationships across the services and user journeys within the wider system, e.g. how preventative care is managed between various healthcare contexts.  The benefits are two-fold. Firstly, you get a clearer picture of the pain points and potential happy paths across a system. If we think about the preventative care example, we could explore how GPs could integrate with community care for more preventative services. Secondly, it helps you to see complexity as a shape-shifting friend not a mortal enemy; it gives you more levers to pull and a greater awareness of what happens to users when you pull them.  

Seeing good practice in action

From the conversations I had at the Summit and beyond, there are pockets of excellent practice already. There are GP practices and ICBs putting users at the heart of their improvement plans, zooming in to patient needs and then mapping the journeys across their own service and beyond. Some teams are running quantitative surveys to explore the drivers behind patient trends and others considering, not just how to implement a policy, but rather what the policy needs to be to deliver the outcomes they want.  

That these activities are growing within the NHS is encouraging, because they are the bread and butter of good design. They are tools that can help ICBs to take a more proactive approach to how they commission and monitor genuinely integrated care. But it can be hard to identify these activities, much less celebrate them, because the health ecosystem doesn’t always call them the same thing.   

Time to speak a new language?

I wonder if the service design community could play its part by changing the way we talk. Accessible language is a cornerstone of what we do, so let’s reflect that in the terminology we use. User-centred is the same as patient-first. Service designers are improvement managers. User journeys are clinical pathways.  

It’s a small point, but it’s in everyone’s interest to keep things simple where we can, because there are even bigger challenges ahead: we will need to bridge the gap between live NHS reforms and future changes to social care.  

Zooming out to social care  

The 10 Year Health Plan envisages neighbourhood teams using the skills of social care professionals to better effect, for example completing blood pressure checks. Yet reform to social care is running to a different timetable, with a commission set to report in 2028.  

The benefits of systems thinking is that it creates a systems mindset, where complexity, ambiguity and unknowns are a natural part of the world you work in. Knowing that reform is coming, and that your system will need to adapt, enables you to make passive provision for that change. Then as the systems continue to interconnect, you can perhaps identify the new pain points and happy paths sooner.   

History is full of the unintended consequences of reform. That’s why I think systems thinking is one of the best tools we have to create genuinely integrated, patient-first care.   

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Amber Polley attended the King’s Fund Summit on Integrated Care. To learn more about user-centred systems thinking, visit the NEC Digital Studio Design School.