@Livelovebehappy if you're interested in the kinds of things I'm talking about, it may be worth googling Brian's Story and The Liberated Method.
I think that public services need to be redesigned to focus on relationships with people, and between services, and between services and the community. We need to focus on listening and learning about what people actually need. Otherwise we have people like Brian bouncing between services, with huge financial implications and ultimately Brian doesn't get the help he actually needs.
This is a problem with the way services are structured and governed, and the way performance is measured. We are delivering services that tick boxes within narrow remits. We are not supporting relationships with people that would lead to their recovery. People don't exist in narrow remits and health is a systemic issue. Many of us are like Brian in some degree, with each of our interactions with public services treated in isolation, when often they are interdependent. See links between issues around fleeing domestic abuse, housing/homelessness, safeguarding, mental and sexual health and child health equity as an example. These issues are often treated separately which is costly, and most importantly not what is needed by the family. Around 80% of determinants for public health also sit outside healthcare services.
When we design public services with and around people, replacing siloed and remit based performance management and governance approaches with human-centred learning and relationships, we can have services that support better lives holistically. This also saves money because we support the broader conditions for health, and people have the healthcare they actually need.
So no it's not about throwing money into an endless pit, there also needs to be change to our public systems including our NHS. Some of this is happening in some places. But I think if there was a greater focus on this kind of reform in public service (including reform to finance and commissioning processes to support them), that would make a big difference. My experience in relational public services has shown this to me, as has my research.
So I think there is a need to shift focus to this kind of reform, rather than accept this as a limited system that is not meeting needs, and just managing numbers.
Reform needs to be about creating systems that work for people. Not making "efficiencies" by cutting funding to siloed services that don't. When services actually meet needs, savings are a natural consequence. When we create the wider conditions for health and see the whole person or family, we also reduce demand. Otherwise we are just managing failure demand and limiting access.