by Carla Rosenthal, Participation Officer
and the PAVO Mental Health team
“No thank you, I do not want to spend six days doing a ‘Vanguard Method System Review Check’ that I know nothing about,” was the common response when I was tasked with the job of organising this event back in March 2016.
“But the results could be used to directly influence housing and mental health services in Powys!” I would counteract when confronted with such replies.
“Great! Tell me what I have to do and I’ll give up six days in my extremely busy working life to come along.”
“Uuuummmm, I’m not quite sure what happens but you have to turn up in Llandrindod, then go to either Welshpool or Brecon, do something there, then come back to Lland’od and it will all make sense.”
“No.”
“Expenses paid.”
“No.”
“Lunch provided - every day.”
“Maybe.”
Eventually, in November last year, individuals working in Third Sector mental health organisations came along to participate in the now legendary, Vanguard Method System Review Check. All I can say is, if you missed it, you missed a goody and despite no-one really knowing what it was all about to start with, by the end of the process, thinking had changed, systems had been unpicked, harrowing tales re-told and sceptical participants left feeling enlightened and in some cases, enriched.
In a nutshell, two teams of 4 - 6 individuals spoke to people we knew in and around Welshpool and Brecon about their experiences of emotional ill health. We examined their contacts with both statutory and voluntary services and found out what had been beneficial and empowering and what had been a waste of time or caused additional distress. The ongoing work was collected on lots and lots of large pieces of paper and got stuck on every available wall in the PAVO offices (white tack only!) then the findings from both teams were collated and clear and simple messages were pulled out.
It came as no surprise to discover that (amongst other things) people across Powys were frustrated by long waiting lists for psychological therapies and fed up with re-telling their story numerous times to a variety of professionals. However, it also became clear that the help, support and advice offered by the likes of MIND and Ponthafren was invaluable and in some cases, life saving.
The six day exercise meant that assumptions weren’t simply what we had heard over the years but provided definitive hard evidence to show service providers who may wish to look at where improvements could be made. The learning that Third Sector providers took away should ensure continuation of people-centred services and a commitment to delivering what matters to those who need it, being at the heart of their service provision - all done without having to spend any extra money.
Following on from the Review Check experience, I tend to question things more and find myself asking, “Why am I doing this? What is the point? Where is the benefit? Could this be done differently or more efficiently?” It’s not a bad way to approach things but sometimes, change needs to come about slowly and not everyone will query things in the same way. Maybe they need the opportunity to go on a Vanguard Method System Review Check . . . ? They might even get a free lunch.
NB: After submitting this blog post, Jackie pointed out that she still didn’t know exactly what the Review Check was all about, so in answer to her questions, please see below:
Why was the Review Check done in the first place?
Information given by Adrian Jones, Supported Housing Manager at Powys County Council:
“At its meeting on 6 January 2016, the Supporting People* Management Board decided to fund an intervention into the housing related support needed for people with mental health issues to live independently in the community with as high a quality of life as possible. The scope of the project was to cover North Powys and South Powys for any person of adult age with mental health issues. The costs of the project would cover the engagement of an external facilitator to use the Vanguard Method of Check and to cover the costs of involvement of staff and volunteers of third sector agencies specialising in mental health, none of whom are (currently) funded by Supporting People.”
What will happen now?
In a nutshell, two teams of 4 - 6 individuals spoke to people we knew in and around Welshpool and Brecon about their experiences of emotional ill health. We examined their contacts with both statutory and voluntary services and found out what had been beneficial and empowering and what had been a waste of time or caused additional distress. The ongoing work was collected on lots and lots of large pieces of paper and got stuck on every available wall in the PAVO offices (white tack only!) then the findings from both teams were collated and clear and simple messages were pulled out.
It came as no surprise to discover that (amongst other things) people across Powys were frustrated by long waiting lists for psychological therapies and fed up with re-telling their story numerous times to a variety of professionals. However, it also became clear that the help, support and advice offered by the likes of MIND and Ponthafren was invaluable and in some cases, life saving.
The six day exercise meant that assumptions weren’t simply what we had heard over the years but provided definitive hard evidence to show service providers who may wish to look at where improvements could be made. The learning that Third Sector providers took away should ensure continuation of people-centred services and a commitment to delivering what matters to those who need it, being at the heart of their service provision - all done without having to spend any extra money.
Following on from the Review Check experience, I tend to question things more and find myself asking, “Why am I doing this? What is the point? Where is the benefit? Could this be done differently or more efficiently?” It’s not a bad way to approach things but sometimes, change needs to come about slowly and not everyone will query things in the same way. Maybe they need the opportunity to go on a Vanguard Method System Review Check . . . ? They might even get a free lunch.
NB: After submitting this blog post, Jackie pointed out that she still didn’t know exactly what the Review Check was all about, so in answer to her questions, please see below:
Why was the Review Check done in the first place?
Information given by Adrian Jones, Supported Housing Manager at Powys County Council:
“At its meeting on 6 January 2016, the Supporting People* Management Board decided to fund an intervention into the housing related support needed for people with mental health issues to live independently in the community with as high a quality of life as possible. The scope of the project was to cover North Powys and South Powys for any person of adult age with mental health issues. The costs of the project would cover the engagement of an external facilitator to use the Vanguard Method of Check and to cover the costs of involvement of staff and volunteers of third sector agencies specialising in mental health, none of whom are (currently) funded by Supporting People.”
* The Supporting People Programme provides the framework by which housing related support services are commissioned and funded within Wales.
Where did Housing fit into all this?
“Housing Related Support plays a key role in the system of early intervention and prevention, which is now being developed through locality-based response by the Council as part of its implementation of the terms of the Social Services and Well-being Act (Wales) 2014. From the point of view of Supporting People, the project was one of co-production to learn about the end-to-end experience of people with mental health issues when they ask for help and to establish a way of working to promote well-being in the lives of people and do the things that matter to people, as is now the requirement by law under the terms of the Act.”
What exactly is the Vanguard Method System Review Check?
Taken from Vanguard Consulting website:
In order to move organisations from a command and control to a systems thinking logic, Vanguard developed a version of Deming/Shewhart’s ‘Plan-Do-Check-Act’ cycle (Deming 1982 p88), with the emphasis on confronting managers starkly with the failings of the current system by starting at ‘Check’.
The first part of check provides a sound understanding of a system as it is and identifies waste and the causes of waste.
‘Check’ asks:
Can you give some examples of some of the exercises you carried out.
Most of the time was spent talking to people who have had experience of the mental health system and use the services provided by statutory bodies and those provided by organisations such as Gwalia Housing Support, MIND groups or Ponthafren. We would ask them questions such as, “What matters to you? What does a good day look like? What would make your life better?” We then went on to map their flow through the system.
Give an example of something that was unpicked in a system currently used.
An example would be looking at someone’s journey from when they had first gone to see a GP about a mental health issue, to being referred to a psychiatrist for an assessment. Usually, drugs are prescribed and appropriate therapy might be offered. However, the waiting list for psychological therapies is unacceptably long.
What were some of the simple and clear messages that were revealed that we didn't know before?
Most things are common knowledge, but the evidence collected showed that people do not want to be passed from pillar to post, telling their story time and time again to others who take little or no notice. Waiting lists for talking therapies are off-putting, medication is often prescribed with no alternative offered and people want to be able to live their lives in the way they want to without being forced to conform to an unattainable ideal of ‘normal’.
What could change as a result of the Review Check?
Where did Housing fit into all this?
“Housing Related Support plays a key role in the system of early intervention and prevention, which is now being developed through locality-based response by the Council as part of its implementation of the terms of the Social Services and Well-being Act (Wales) 2014. From the point of view of Supporting People, the project was one of co-production to learn about the end-to-end experience of people with mental health issues when they ask for help and to establish a way of working to promote well-being in the lives of people and do the things that matter to people, as is now the requirement by law under the terms of the Act.”
What exactly is the Vanguard Method System Review Check?
Taken from Vanguard Consulting website:
In order to move organisations from a command and control to a systems thinking logic, Vanguard developed a version of Deming/Shewhart’s ‘Plan-Do-Check-Act’ cycle (Deming 1982 p88), with the emphasis on confronting managers starkly with the failings of the current system by starting at ‘Check’.
The first part of check provides a sound understanding of a system as it is and identifies waste and the causes of waste.
‘Check’ asks:
- What, in reality, is the purpose of this system?
- What is the nature of customer demand?
- What is the system achieving?
- How does the work flow?
- What is value work and what is waste?
- Why does the system behave like this?
Most of the time was spent talking to people who have had experience of the mental health system and use the services provided by statutory bodies and those provided by organisations such as Gwalia Housing Support, MIND groups or Ponthafren. We would ask them questions such as, “What matters to you? What does a good day look like? What would make your life better?” We then went on to map their flow through the system.
Give an example of something that was unpicked in a system currently used.
An example would be looking at someone’s journey from when they had first gone to see a GP about a mental health issue, to being referred to a psychiatrist for an assessment. Usually, drugs are prescribed and appropriate therapy might be offered. However, the waiting list for psychological therapies is unacceptably long.
What were some of the simple and clear messages that were revealed that we didn't know before?
Most things are common knowledge, but the evidence collected showed that people do not want to be passed from pillar to post, telling their story time and time again to others who take little or no notice. Waiting lists for talking therapies are off-putting, medication is often prescribed with no alternative offered and people want to be able to live their lives in the way they want to without being forced to conform to an unattainable ideal of ‘normal’.
What could change as a result of the Review Check?
One of the great things about this review check was the way that the third sector organisations got to grips with the process. We know that at least some of the groups involved are keen to have their own ‘check’ to make sure that they are really meeting people’s needs in the way that is best for those people.
It showed us how inter-linked everything is and how we can all support each other to make changes. It is certainly a challenge, but we know that at PAVO and in the wider third sector there is a lot of interest in working with statutory bodies to see how our learning can support this kind of thinking at a wider level in the mental health system. We are confident that there would be interest in this from the statutory services too, especially with the developing emphasis on prevention and early intervention. Everyone wants the system to work for people, the Vanguard Review Check process can show how very established systems can sometimes just keep doing what they just keep doing and that a fresh look can show where there are blockages and how to meet people’s needs more effectively, so that more people can be helped, often at lower cost too.
It showed us how inter-linked everything is and how we can all support each other to make changes. It is certainly a challenge, but we know that at PAVO and in the wider third sector there is a lot of interest in working with statutory bodies to see how our learning can support this kind of thinking at a wider level in the mental health system. We are confident that there would be interest in this from the statutory services too, especially with the developing emphasis on prevention and early intervention. Everyone wants the system to work for people, the Vanguard Review Check process can show how very established systems can sometimes just keep doing what they just keep doing and that a fresh look can show where there are blockages and how to meet people’s needs more effectively, so that more people can be helped, often at lower cost too.
What will happen now?
We will continue to support this process as an effective way of making changes that start with the people who use (or avoid) the services. Implementing change to deliver the right thing at the right time does need some careful consideration before real benefits can been made. It also needs everyone involved to be united towards the same goals and be willing to look at things with a fresh perspective.
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