Steve Broome and Rebecca Daddow discuss a Whole Person Recovery (RSA Journal Winter issue 2010) – under which the results of the activity are paid for, rather than the condition-treatment. In this case, the focus is people who need help with drug and alcohol addictions. The person with the condition is centrally involved in choosing how their own condition will be treated. This is an example of the topical ‘outcome-based-payment-by-results’ model for financing public services. It is a move to treat public funding as an investment in recovery, rather than risk financing services which perpetuate dependency (both by service users and service providers). Interesting implications flow from this:
- there is good evidence that if people with long term conditions (such a diabetes) are involved in their own condition management, it mitigates their symptoms
- part of the challenge of providing services (especially ‘care’ services) is that service users relate both to the service-as-service, but also as an ‘object’ to which they relate through ‘acting out’ whatever has to be communicated that cannot be said, directly. The whole project of ‘payment-by-results’ has yet to take this into account
- to what extent can we change behaviour without changing context – either external or internal? If I am involved in my own cure, I am changing my internal context – even if the external context I am in is resistant to change. My relationship with significant others (as intimate companions with whom I have a real relationship) are critical in this.
- The behavioural economics’ change projects of governments eg Mindspace place an emphasis on both the ‘companion/adviser’ who accompanies you in your change; and the self-shaping use of narratives and goal setting to get me to stick to my commitments to my goals.
Slingshot