"Silly Rules": Breaking the Rules for Better Care and Integration

Background: Wales faces familiar but deep-rooted challenges in health and social care: workforce shortages, rising demand, stretched resources, and fragmentation between services. Despite strong policy commitments and structures for integration, people still experience disjointed pathways while staff navigate processes that sometimes add work without value. To better understand these pressures from those who live and work within the system, the Bevan Commission, in partnership with Llais (the statutory voice of the Welsh public) and the Institute for Healthcare Improvement, launched ‘Silly Rules’, a national campaign to uncover the everyday barriers that get in the way of good care and improvement. By surfacing examples directly from those affected, the campaign aimed to support organisations and teams to identify opportunities to simplify processes, release time, and strengthen integration for the benefit of people, staff, and the wider system.

 

Approach: A bilingual open survey invited people with lived experience (patients, carers, families, and service users) alongside the health and care workforce to share examples of ‘Silly Rules’. The central question asked: “If you could break or change any rule(s) to provide a better care experience for patients, families, or staff in Wales, what would it be?”

 

Participants were also asked whether they were responding as members of the public or workforce, whether their example related to health, social care, or both sectors, and for basic details such as role and location. Responses were systematically coded against ten themes (including Operations, Workforce, Clinical Services), with qualitative and computational text analyses used to identify cross-cutting and co-occurring themes.

 

Results: Over 780 participants from across Wales contributed more than 800 “rules”, including members of the public, carers, and staff from all seven health boards and multiple local authorities. While most rules related to healthcare (68%) and a smaller number to social care (3%), 23% referred to “both health and social care”.

Upon closer analysis, over 30% of all responses related to some aspect of Integrated Care. These were mapped to the IFIC Pillars, with people and partnerships in care and digital solutions emerging as the most frequently raised themes. showed how small procedural changes (e.g., enabling shared digital access or reducing unnecessary referrals) could release time, capacity, and morale while improving safety, experience, and organisational efficiency.

 

Implications: The findings reveal that unnecessary bureaucracy and rules are not trivial frustrations but shared challenges that can unintentionally hinder care quality and integration. For Wales and beyond, the message is clear: progress towards integrated, person-centred care will depend not only on aligning rules, processes, and accountabilities, but also on reviewing them - keeping what adds value and simplifying or removing what does not. ‘Silly Rules’ has given a voice to people and professionals who experience these barriers every day and helps organisations identify where efforts to join up care can also build trust, efficiency, and empowerment. It highlights a culture ready for improvement - one where removing waste and restoring common sense strengthen both the experience of care and the sustainability of the system.