By 2035, the One Devon Health and Social Care system is prevention-oriented, digitally sophisticated, and genuinely collaborative with regards to workforce planning and decision-making across different organisations and professions. While we are still on a journey to fully achieving our ambitions in some respects, it is undeniable that a significant distance has been travelled since the early 2020s, and there is an increasing sense of confidence amongst the workforce that the system is up to the task of meeting the challenges of 2035 and beyond - as well as pride at having overcome severe difficulties and crises to get here.
The 2020s and early 2030s have seen important changes take place across a number of key areas, with far-sighted leaders and planners taking a range of forward-thinking actions and decisions which we now see bearing fruit. As described in further detail below, these changes have had the cumulative effect of making Health and Social Care in Devon a more rewarding sector in which to work, and Devon a healthier place in which to live - moving us closer to making the hopes and ambitions of the early 2020s into a reality, and helping us to avoid the worst fears and anxieties from this time from being realised.
Firstly, there has been a successful shift towards prevention in terms of the resources allocated across the system, beginning in the late 2020s and gathering pace in the early 2030s. In part, this has been enabled by a redoubled focus on promoting public health from the early 2020s onwards, with habits and lifestyles conducive to individual and collective wellbeing now forming an integral part of school curricula and helping to inculcate a greater sense of personal responsibility with regards to one's health amongst people in Devon, in particular younger generations. The shift has been further driven by a proliferation of social prescribing, as well as a growth in approaches such as peer health coaching intended to promote health education and awareness in the community. Of course, it has been important to recognise that culture and habits can take a long time to change, and there remain sections of the population - particularly amongst the elderly and in the continuing pockets of deprivation in parts of the county - where demand for acute care remains high by recent historical standards. Nonetheless, the overall impact of the shift towards prevention has been to ameliorate health inequalities across different localities in Devon, while also starting to alleviate the pressure on Devon's acute care services.
Secondly, our use of technology has become more sophisticated and efficient with regards to its role in helping the workforce and its impact on the patient experience. During the 2020s, the many different parts of the One Devon healthcare system underwent a successful transition to using one fully integrated and interoperable IT system. This has come to be seen as a milestone moment in the recent history of Health and Social Care in Devon, helping both to increase the day-to-day usability and convenience of Devon's digital system for the workforce, and to foster stronger links between previously digitally-disparate organisations working across the county. Other key actions in this respect include the mandating of digital literacy training for staff as a key part of Continuing Professional Development, the implementation of a smarter approach to commissioning for digital tools and equipment with a focus on open source interoperability across different providers, and the increased prevalence of digital tools such as Hololens, virtual wards and the NHS app as ways of improving the patient experience. While care has always been taken to preserve the 'human element' of healthcare in Devon in recognition that digital solutions are always not desired or appropriate, there has also been work to ensure that all people in Devon have equitable access to digital tools should they wish to access services in this way.
Next, partners across the One Devon system have embraced a truly collaborative, systems-oriented approach to strategic decision-making, including regarding workforce planning. Several changes to governance and commissioning structures have helped facilitate the adoption of this approach, such as wider system representation at the ICS-level (including of universities) and a move towards longer-term funding cycles nationally, opening up greater space for creative long-term thinking regionally. This wider sense of what the 'system' is has also fed into the way in which the ICS as an actor now seeks to use its influence in a strategic way in relation to local priorities in areas such as housing, education, food and the economy - all highly relevant to the long-term strategic challenges faced by Devon's healthcare system in the 21st century. The overwhelming sense amongst most of those working in Health and Social Care in Devon in 2035, whether as frontline staff or at a leadership level, is now of 'serving Devon, rather than our organisation' - with the barriers between different providers gradually diminishing in importance in recognition of the shared challenges we now face across the whole system.
This adoption of a more collaborative approach to strategic decision-making and planning has ultimately only been possible because of concerted efforts made in the 2020s to achieve genuine integration between Health and Social Care, with a greater parity in this respect a prerequisite for the implementation of a truly whole system approach to tackling shared challenges (particularly with respect to workforce). Following decisive action at the local, regional and national levels to stave off immediate crisis in the early 2020s, pay and working conditions in social care have undergone a sustained improvement, helping to bring about a gradual transformation in the public perception of the sector. Changes in commissioning arrangements have also helped to improve retention and recruitment of the workforce of social care - such as, for example, a move away from funding care work by time and task, providing greater autonomy to care workers to support the people they care for as they feel is most appropriate. In addition, an increased emphasis on the joint delivery of training where possible has supported the development of strong relationships and common understanding between Health and Social Care, while better recognition of learning achievement and skills in the care sector has helped change the perception of care work as being 'unskilled', with greater numbers of people now moving between the Health and Social Care parts of the system throughout the course of their careers in healthcare. With an ageing population a visible and undeniable part of our reality in 2035, no one can deny the importance of social care work in supporting the dignity of millions across the country, and in Devon there is now a clear sense that the sector is valued accordingly.
Relatedly, a reconsideration of roles and responsibilities more broadly has also helped to make healthcare in Devon more rewarding to work in, with tasks now allocated across the workforce in a more efficient way, greater numbers of staff enjoying opportunities for portfolio working, and better prospects for career pathways and progressions encompassing the full breadth of the system. Training and education has been pivotal in bringing about these kinds of shifts - there is now a greater focus on the development of generalist skills across the workforce, and educational institutions are engaged increasingly early with regards to their role building up key skills and competencies amongst the local population in Devon. Training and professional development, meanwhile, has become more 'locally centralised' at several Devon training hubs, which act as crucial nodes for the exchange of learning and knowledge and the building of relationships amongst those working in Health and Social Care in the county. Looking back, we can attribute much of our progress in these areas to the development of a real and tangible workforce plan in the early 2020s, encompassing the whole system and supported by key educational institutions. This helped create a culture whereby long-term, coordinated and strategic thinking around skills and training is now the norm, and in which the promotion of opportunities for learning and career development acts as an effective 'selling point' with regards to recruitment and retention.
Finally, it is important to recognise the benefits to the patient experience that have arisen as a result of these successes in strategic planning and decision-making. The typical person accessing the health service in Devon in 2035 enjoys a seamless, simplified, 'joined-up' experience, with different parts of the system collaborating and coordinating more smoothly and effectively at different stages in the patient journey. Better waiting times for emergency care, along with the accessibility and usability of digital options for accessing advice and care, have also helped boost public trust in Health and Social Care services in Devon - a virtuous cycle with benefits for both the pride and professional enjoyment of those working in services and the quality of care experienced by people locally. Indeed, this is not the only factor that has helped to increase the professional satisfaction of the Health and Social Care workforce in Devon - efforts have been made to make Devon's hospitals more convenient places to work, for example through the provision of subsidised parking and onsite nurseries, while a balance has been found (following much consultation locally) between the local and the central delivery of services which is well-suited to the needs of both the workforce and patients.
Each of the above factors has in turn contributed towards a growing sense locally that a career in Health and Social Care in Devon represents a rewarding, exciting and meaningful option. This is something that has proved key in enabling the One Devon system to overcome the most severe recruitment challenges of the 2020s, and to build a diverse, stable and sustainable workforce fit for meeting the needs of the people of Devon through the 2030s and beyond.