Connecting the connectors
As part of our wider focus on how to generate health and well-being in partnership with the NHS, we brought together a group of people working on health and well-being to discuss:
Whether they would like to continue meeting to share insights and build relationships between them.
To identify topics that might be of value to them for us to explore in the wider Better Way network.
This was the second meeting, following an initial ‘get to know each other’ session in 2022.
Caroline Slocock, a Co-convenor for a Better Way, began by updating them on what had been happening on health and well-being within the network. There had been a roundtable on the NHS and Communities to explore how to put the NHS’s recent guidance into practice. The network had also been holding a series of meetings looking at the kind of leadership needed to build health and well-being. The first was on practising well-being as leaders, and we had held another on the leadership needed to build health and well-being in society, which would be explored further on 17 April. A Better Way had also had discussion on why we need a relational state and how to create it.
Insights from these and other discussions in the network, which a Better Way was planning to explore in a session at the forthcoming NHS #StartWithPeople conference on 30 March, included:
Invest in communities’ capacity to engage with the public sector in an equal relationship so they have the power to shape the things that matter to them.
Take on people from the community as staff and volunteers, and develop the cultural competence to reach out to all communities.
Focus less on bringing people into committees and more on creating spaces within communities to explore together how to redesign services.
Put people’s needs and stories, rather than institutional agendas, at the heart of service design.
Invest in the time, resources and relationships to make it possible to really join forces.
More information on these is available in our annual roundup, At a Tipping Point?
She also explained how a Better Way worked and the benefits it could bring – as well providing a space for sharing ideas and building momentum for wider changes, members also appreciated the way in which the network helped forged new connections, strengthen relationships and deepen mutual understanding.
In the discussion within the group that followed, it was agreed that:
The group should continue to meet at roughly monthly intervals online for 1.5 hours, initially over a 4 months’ period.
It should start with existing members but consider over time who might also join it so that the group could become even more representative of the forces that shape health and well-being. It might be worth bringing in people from areas like housing, social care and arts and culture, for example.
The focus of the group should be on ‘what we can do together which we cannot do alone’, providing an informal space for discussion informed by presentations, people thought. Ultimately, the issue was how to build on the energy and work that already exists to form a movement that makes the Better Way principles and behaviours the norm.
Members could in turn use their own networks to communicate insights from the group and socialise new ideas outside.
The group also identified topics that might be explored either by themselves or more widely within the network. These included:
The development of participatory leadership, developing an open, exploratory mindset, in the NHS and elsewhere.
Understanding and communicating what sharing power really looks like and what it means when communities take it on.
How to overcome the moral injury being experienced by the health and social care work force because they feel they are not being listened to or ignored.
How to create a movement of people who care about and for others, at a time when the demand for care is outstripping the ability of formal services to deliver it, and create what the Archbishop of Canterbury called ‘a new social contract’.
How to change commissioning to support a more networked based approach.
How to develop genuine co-production and co-delivery, including peer support and developing peer leadership to develop agency, and move away from the ‘them and us’ mindset.
How to build a movement for change.
Joining forces for Integrated Health and Care
The advent of the Integrated Care Systems should be an opportunity for organisations across sectors to join forces in a way that was not possible before. But it all seems a bit daunting. ‘So how should this best be approached?’ was the question we explored in this meeting.
Our first speaker was Samira ben Omar, previously Head of System Change at the North West London Collaboration of Clinical Commissioning Groups, and now working independently.
Our second speaker was John Mortimer, previously at Vanguard Consulting, now also working independently.
Here are some of the key points made by speakers and in discussion:
The formal health system cannot bring about good health by itself. 80% or more of the drivers of health are elsewhere. The NHS needs to join forces with others.
There are serious problems of health discrimination and inequality, made more evident during the pandemic. So when joining forces, it is always necessary to consider who is included, who needs to be reached, and what discriminatory policies or practices need to be tackled.
It is important to unlearn, in order to shift towards a more creative and relational set of practices. In particular, we need to move away from the proliferation of committees, which have often become a ‘place of performance’, rather than drivers of improvement or change.
Instead, we need to establish new spaces for people to come together to share power, from neighbourhood level upwards. The ‘Us & Them’ culture is toxic in the health system. We will only address that if we create more opportunities for people to discover their shared humanity.
It is important not to make assumptions about what people want. Instead, we need to shift the whole system towards person-centred design. This includes asking open questions, listening together, bringing back answers. It also means giving front line teams the freedom to organise their work differently: to understand at first hand the experiences of individual people in the system, then experiment, prototype, and make normal.
Public sector organisations need to ‘let go’ more. Communities do most when they can decide for themselves, it was said.
We need to remember that in partnership working the quick fix is never successful. Worthwhile change will take time, and commitment must therefore be long term.
We need to resist pressure from NHS England or elsewhere to meet immediate targets, and we should be wary of putting too much faith in new structures. It’s the shared purpose held by committed people connecting across organisations and sectors and hierarchies that will get the best results.
New Public Management, with its fixation on target-setting, cannot co-exist with Integrated Working, which needs the freedom to practice relational methods. The former has failed to drive down costs and improve health outcomes - the latter now needs to be given a chance.