Roundtable on the NHS and communities
On 31 October 2022, we held a roundtable to consider how the NHS and communities can join forces, including looking at how Better Way principles and behaviours can help and discussing new NHS England statutory guidance on partnership working with people and communities to improve services.
Opening speakers
The NHS Guidance
Olivia Butterworth, Deputy Director, People and Communities at the NHS, opened the roundtable with an introduction to the guidance and the challenges and opportunities in implementing it. The guidance covers a hierarchy of activity - from informing, consulting and engaging, to co-design and co-production - and in all of these cases the place to start is with people and communities, the guidances says, not from institutions. Statutory guidance has been in place since 1972, she explained, but with this new guidance they hoped to change practice fundamentally. They wanted to move away from a situation where institutions seeking to communicate with communities adopt a medical model of health, start from problems rather than strengths, and often use their own jargon and language, which puts people off. Another common pitfall to avoid is simply bringing people into governance structures instead of genuinely reaching out to people on their own terms.
The guidance sets out 10 principles, all of which would probably be familiar, she said.
The challenge now, she explained, is to really live the principles - building on what’s strong, not what’s wrong, listening to people and their stories, rather than attaching labels, and allowing communities to tell their own stories and set their own agenda. That requires a different kind of partnership working for the NHS and is especially challenging given the power imbalance that naturally exists because it holds the purse strings.
Healthy Communities Together
Our second opening speakers, Clare Wightman and Sarah Raistrick, talked about the Healthy Communities Together initiative in Coventry, where public and voluntary sector partners are working with people in communities to shift inequalities and redesign services. Clare is the CEO of Grapevine, Coventry and Warwickshire and Sarah is a local GP and a non-Executive Director with the Herefordshie and Worcester Integrated Care Board.
Clare said she wouldn’t normally start by talking about resources but it was important to realise that this partnership was made possible because of resources from the Kings Fund and the National Lottery Communities Fund, which were specifically aiming to shift inequalities by building public and voluntary sector partnerships. Grapevine’s lens in approaching this work is about shifting power and ‘diving right back down to reality’, being strengths based and working with people to identify their ambitions, she explained.
Healthy Communities Together first spent time building relationships within the partnership itself - Grapevine, Coventry City Council Public Health Department and Coventry and Warwickshire NHS Partnership Trust. Then they brought professsionals, the Head of Acute Services, the local GP, the vicar and other players in the community into one room to listen deeply to a person with experience of mental health issues. After further intensive engagement with the community, this led to a wider plan to improve the support available to him and others. Clare explained that over time it had not proved possible to keep the same team together in the same room. So they had responded by setting up core teams, with a changing membership, to regroup and flex around issues. They also shared learning continuously - ‘working out loud’.
Sarah told us that a lot of what they’d learnt they had already known intuitively, including the link between mental health and social circumstances, but the act of a person telling their own story proved very important, not just for them but especially for those hearing it. They asked, ‘What keeps you well?’ and heard that it was often family, friends, a job, their house and their pets; and they learnt a lot about what people need, how frustrated they are by the way we set up structures and how they could work better together. As a result, for example, men’s groups had been set up that were transformative for those involved.
Both Sarah and Clare talked about the challenges as well as the achievements. It was hard to achieve change at scale, turning round the oil tanker was difficult, and they’d found a gulf between board level and community commitment to this approach and the buy-in of middle levels. Keeping partnerships going was also challenging - keeping commitment live, staying human and being human with each other and moving forward as a team.
Creating new sources of power in the community is critical, Clare concluded: empowerment of people is the only way to change things. To do that, you need to get to know your patch, and get into every street, and bring local people into services, as volunteers and in advisory groups. And she emphasised the power of shared stories - with people and professionals listening and talking to each other.
You can read more about this partnership here.
Inspired Neighbourhoods
Our final opening speaker was Nasim Qureshi from Inspired Neighbourhoods in Bradford who told us how they co-create and co-design services with their own community and empower people to change their own lives, which is critical to creating better health and well-being. Nasim told us about a number of strategies that help it to achieve this:
The organisation is made up of its community. 95% of its supply chain and staff are local, starting with the volunteers, and 90% of its Board. Inspired Neighbourhoods has 109 staff and 26 volunteers.
They get to know their patch, drawing a 2 mile radius around each of its 6 centres, spending time with the community on the streets, working peripatetically, and finding out about all the organisations operating there.
They provide well-being services across a full range, and all of these are inter-related. They don’t send people from pillar to post.
They work with local partners on an equal footing and support them - delivery matters, not who delivers them.
You can find out more about this process from this blog by Nasim.
Nasim ended with a plea for a different form of commissioning of services which is relationships based.
Points from the breakout groups and discussion
Some of the points made in discussion and breakout groups include:
It’s important to join forces to work with communities, take the time to build relationships within partnerships and with communities, listen deeply, share and build power and demonstrate that change is happening.
For people and communities, there can be a sense of fatigue to be overcome (will I be heard? Will anything happen?). This is especially true if there are lots of different people talking to them and not talking to each other. Join forces with other organisations - no one organisation can bring about this change.
Talk human, and be human when you work with people and communties. You need to avoid labels and the medical model to really communicate with people and communities.
Professional boundaries are a barrier and need to be broken down so that they can work with the whole person, rather than passing them from pillar to post, and bring their whole selves to the job. People working inside the NHS are themselves under enormous pressure and it can be challenging for them to find space and time to work in new ways. Both sides, communities and professionals, are lifted by shared stories and this process helps to break down those barriers.
The door is open to change the wider system but culture change in the NHS is an enormous task. The mental health system itself is broken. It can seem overwhelming but you have to start small, with pockets of good practice, to achieve scale over time. Take risks, make mistakes and take multi-pronged actions.
Make sure the community ‘sees itself within you’.
Money matters, unlocking the time and resources required.
Mutually supportive networks, like a Better Way, help to share knowledge and insights.
The respondents
We concluded the event by hearing from two respondents.
Samira Ben Omar, who has extensive experience of working in the public sector and the NHS and deep experience of putting it into practice, made a number of points:
Don’t forget that the NHS and social care workforce are themselves part of the community, so listen to them too and use their contacts.
People and communities are already empowered - the reality is that institutions need to relinquish power rather than to empower, a truth seen during the Covid pandemic.
Communities understand complexity: it’s institutions that don’t.
Words matter and it is progress that we are talking about people and communities and have moved from the market paradigm and the language of patients and clients.
You can read more about lessons from Samira’s work with communities in this Better Way essay.
We then heard from Steven Platts, the CEO of Groundswell, a homeless charity which deploys peer support and peer research to help homeless people access services and which has also recently worked with the NHS to bring ex-homeless people into support and other roles in the NHS. Steven’s reflections included:
The NHS guidance is an opportunity to elevate what’s already been happening over the years.
He encouraged the VCSE to take this opportunity to reach out to the NHS. There has been a trickle down in the willingness of the NHS to engage, with resources - eg Groundswell are now undertaking training in co-production paid for by an Integrated Care System.
Building relationships takes time.
Next steps
In conclusion, Olivia Butterworth said that we needed a new model for working, with true collaboration. The NHS is working with a Better Way to see how this network might help and any ideas for topics we might explore would be welcome. One suggestion was that we might look further at how to address the barriers within the NHS to this way of working.