This week I attended a 24 hour 'simulation'. Sounds a bit rude doesn't it? Alas it was a 'game' looking at health and social care in 2012 in 'Crafton', a fictional city in central England. 50 of the UK's top people in the field, all of us 'in role'. I was very excited to be going, it sounded like it was going to be a ball. Worth 24 hours away from the business.
Was it worth it? Well, a bit. But perhaps my expectations were too high. What felt like it should have been a creative exercise felt like a bit of a technocratic conversation captured, I felt, by the mindsets that helped get us into the mess we're in today: a highly bureaucratised, professionally dominated, managerialist approach which costs a fortune while delivering very mixed results.
The triple-whammy is well understood: shrinking resources, a changing NHS and a social care time-bomb. The answer, broadly speaking, is a new settlement between citizen and state, personalisation of resources and a massive pooling of budgets in the public sector. This would see rapid shrinkage of acute health services and much more investment in the community sector so that people could help themselves and each other a lot more easily. 'Difficult' people and families who currently absorb tens of millions in every area on a plethora of public would have much less spent on them - but with better results. Preventative projects would forestall all sorts of problems before they became expensive.
The challenge at the moment is that most resources are deployed in ways that are difficult to unpick. Dis-investing in stuff that exists is very difficult, especially when those services contain highly qualified, relatively powerful people. Having seen this group work, over 24 hours, on Crafton's issues - I came away depressed. The group didn't seem to have a sense of the potential of people do to far, far more for themselves and each other. Nor did they grasp the importance of political and civic leadership in making the debate. At times, I felt I could be at any gathering of top managers over the last few years. Lots of talk of 'pathways', 'flows', 'joining-up' and so on. Often very technical and based on the idea that bureaucracies are highly improvable.
I shouldn't be too critical. These are people who are in the front-line, managerially speaking, and I respect them. They are bright enough to earn plenty of money if they chose to. Most have commitment oozing from them. But I came away depressed. It might have been me. I wasn't exactly full of ideas myself - but I just felt outside the culture, like having to speak in a second or third language. Perhaps I am just not really part of that world. Yet I do meet people, all the time, who are on my wavelength, just not that day.
Next time I am asked on a 24 hour simulation I may just simulate being too busy.