Rigidity and system change

Please note; we are in the midst of a thorough re-construction of these pages. For the moment, there may be some duplication of material from elsewhere; and probably some broken links. Bear with us. Its a lot to cover......

Hard to engage systems

In recent years, and especially over the last decade, we have seen the arguments of the social model of disability being applied to homelessness, and to the more complex personal and 'psychological' issues that arise with homelessness, or give rise to it.

Overly rigid procedures, eligibility criteria or commissioning focussed too narrowly on short term solutions for long term problems can mean that those with more complex needs are then more at risk of falling through society's safety nets, drifting or crashing into exclusion.

In 2006, the UK government produced a report, called "Reaching out: an action plan on social inclusion" (HERE) , which argued that a large part of the problem of so-called 'hard to reach' people with 'complex needs' was as much to do with the inflexibility of services, which allow many people to simply slip out of reach.

This report, along with the thinking behind it and the programmes that it led to (such as the National Social Inclusion Programme for mental health, or 'NSIP', and other programmes in similar vein, such as Supporting People), have been identified as some of the more significant developments in the history and the origins of the PIE approach (HERE).

 

Calls for system change within services

More recently we see a chorus of voices calling for system change, not now coming 'top down' from government, but more often 'from the bottom up'.  Some of those comes from 'providers'; and some from those who work with and support 'provider' services.

The UK Big Lottery's Fulfilling Lives programme (HERE) sought explicitly to fund services that had some prospects of delivering not just innovative individual support models, but vehicles for person-centred service change; the 'systems broker and navigator' (HERE) approaches, for example, or Bristol's 'Golden Key" (HERE) grew from this aspiration.

Yet these well-crafted and well funded efforts also demonstrated the enduring rigidity of the wider systems in which they attempted to introduce more fluidity, with limited success.

The New Systems Alliance (HERE) was formed in 2019 as a mutual support group for services trying to forge a new approach, with still more radically person-led services.

 

Calls for system change - the theory

Some of this rethinking critique comes from quite 'high level' thinking. Joy MacKeith's recent Enabling Help report (HERE)  pinpoints four dominant ways of thinking that have led to unhelpful or 'disabling' service provision.

More broadly still, as an equally forensic critique of misguided paradigms of expertise, the Cynefyn framework (HERE) identifies the dysfunctional results when the wrong approach to expert knowledge in decision-making is applied in circumstances where it does not go

The Human Learning Systems (HERE) similarly mounts a powerful critique of the impact of New Public Management in this area, and on the commissioning culture - 'the purchaser/provider split', that then seeks simple, marketable solutions to complex, systemic problems. Instead, HLS advocates for trust and constructive dialogue between planners and services.

 

Skewed research and evidence paradigms

It has been argued that the demand for 'evidence based' treatments, especially in the health services, had unwittingly tended to exacerbate this tendency, in giving precedence to mainstream-able and standardisable treatments (HERE) and marginalising those for whom such off-the-peg treatments have failed.

Meanwhile, the convincingly large datasets required for such quantitative evidence inevitably cannot recognise the very person-centred interventions often needed for these groups, nor the importance of the context, the pathways, nor the healing power of personal relationships.

Until it was wound up in 2022, the Alliance for Useful Evidence (HERE) had also mounted a consistent challenge to 'policy-based evidence, and mis-leading, skewed assumptions of what passes for valid knowledge on which to base policy and funding decisions.

NB: With the loss of the Coalition, the baton passes to a more disparate collection of agencies from various fields; links to follow.....

Further reading, listening and viewing

PIElink pages

Whole systems as PIEs ; HERE

A PIE of pathways : HERE

Gaps and Barriers : HERE

Rigidity and system change: HERE

A single framework : HERE

Spaces of opportunity 101 : HERE

Can commissioning help to encourage PIEs? : HERE

'Navigators' and 'system brokers' : HERE

(PIE Abacus for) Local practice networks and service ecosystems : HERE

A selection of like-minded agencies & colleagues

Beyond Outcomes (Enabling Help) :  HERE

The New System Alliance : HERE

Human Learning Systems : HERE

Fulfilling Lives : HERE

Collaborate CIC : HERE

Lankelly Chase : HERE

 

Library items

"Reaching out: an action plan on social inclusion" UK Cabinet Office: : HERE

A very brief history of PIEs : HERE

"Theory of Change: a summary":Lankelly Chase : : HERE

"On Behaving Like a System" Lankelly Chase : HERE

"10 Strategies to End Chronic Homelessness" United State Interagency Council on Homelessness  : HERE  (NB: the details here are US-centred, but the overall approach is relevant elsewhere)

"Exploring effective systems responses to homelessness": Naomi Nichols & Carrie Doberstein (for The Homeless Hub) : HERE

"Do 'complex needs need 'complex needs services'? Part Two"   Robin Johnson: HERE

The importance of relationships in knowledge translation and implementation (CHI Impact festival webinar): HERE

Big Lottery Fulfilling Lives' Complex needs' programme: HERE

"System change brokers" (an interview with Alex Smith and Ray Middleton) : HERE