What can we do for the 'rarely reached?'

Last week I took part in a discussion with a group of people who live with dementia. It was the latest of fifty or so similar discussions with people who either do not or cannot participate in traditional civic arenas. We have talked with older people, people with learning difficulties, the blind, stroke survivors, army wives, those living on the lowest incomes and many others. The discussions have been remarkable in all sorts of ways. And, things are emerging - things we can learn from and apply to the way we work.

I work for Wiltshire Council - a progressive forward thinking local authority. I am proud of our commitment to social inclusion and I would not want any other job. But the discussions have shown me that we have a long way to go - a very long way.

It is easy to sound a bit high and mighty about all this but I am not, really not. What we have learned turns our understanding on its head. These people are not hard to reach, no way - these people find it hard to reach us. Sad but true. We are quick to label people according to their needs and to direct them towards functional interventions with structural interfaces. These approaches often dehumanise our responses, compartmentalise and fragment our interventions and more worryingly they often exacerbate the very concerns we are trying to remove.

And the sad thing about all this is that the professionals we have worked with all share a real dedication and commitment to their work - often going the extra mile for their clients. And therein lies the root. The problem is not a lack of commitment or compassion, the problem is fundamentally systematic.

And maybe the answer to this is to design people led, situational services. Services that join up around a person and their personal situations and circumstances. Services that are designed with and by the people who need them.

At the dementia workshop people spoke about the fear of diagnosis and the feeling of terror when those fears were confirmed. This is the point where people are at a low point, depressed, confused, anxious and adrift. And this is when public services first come into sharp focus. These people suddenly need advice, support, help. Help with employment issues, benefits, treatments, transport, care, housing and much more. The advice is out there on the web, from customer services teams, in leaflets, from practitioners. It is all there, funded and waiting for the contact. But what seems thorough, comprehensive and accessible to the public sector often seems impenetrable, inaccessible and fragmented to those who seek our help. Each service does its bit, has its web page and leaflet, has its frontline staff ready and waiting. But it just does not join up - it lacks integration and coordination. The people with dementia talked of returning from the GP with a diagnosis and no clue about what happens next. Surely, that is a predictable service pathway, surely that is the point where services should be integrated - at that critical initial access point.

A comprehensive information pack for those diagnosed with dementia would be a simple step that would make a very big difference. This is just one simple insight - many, many more have emerged from the Wiltshire Voices social inclusion programme. Perhaps it is because we still view people as service clients that such obvious things are overlooked. Perhaps it is time to change our viewpoint and make these discussions part of the service design process from the very start.

So, let's start now.