Starting from the assertion that “The NHS belongs to the people” https://www.gov.uk/government/publications/the-nhs-constitution-for-england/the-nhs-constitution-for-england I was intrigued as to how we could harness the deeply ingrained and valued principles of the NHS Constitution into the ‘health as a social movement’ reality espoused by Simon Stevens in 2014. Clearly some understanding about human psychology was needed to bring onto play as well as a whole heap of convincing and influencing of the ‘great and the good’ to let us give it a try. We had little to lose and a lot to gain, yet even then, we were expected to leap through fiery hoops of financial assurance, and provide evidence of a realistic ‘route to cash’, after all we were making the bold and audacious request to allocate £7,500 to cover the set-up and implementation of the project in 2018/19. Clearly our superabundant budget request sent the financial risk worry beads hurtling into orbit
Therein started a series of seemingly endless briefing papers project plans, business cases and presentations to boards and groups of siloed people. As an aside, we are more than happy to share any of these documents to those of you who may wish to emulate our model and intend to load as many as possible onto the portfolio page on this site, but please be mindful that even when armed with countless eloquently written documents, you are still likely to have a challenge convincing those with ‘the power to permit’, to put aside their incredulity and hysterical laughter for a moment and hear what you have to say. One piece of advice for you find your allies, you’ll need them to help maintain your resilience, and as Helen Bevan says “Go for no!” (https://twitter.com/helenbevan ). You have to be tenacious and be prepared for many closed doors and rejections if you want to succeed and join the well trodden path of the people in the graphic below.
Committed individuals who are drawn to working to improve the lives of others are found in their masses in the UK ‘caring industry’, however regulatory and financial targets have increasingly become key focusses for organisational leaders, severing in the minds of some, the connection between what makes the NHS the ‘National Treasure’ that it is and the constant struggle and demands to deliver commissioner driven targets.
Integration is the way forward, we are told, however in the minds of many commissioners, regulators and leaders, provider organisations need to be directed and commissioned by way of hard negotiated contracts to deliver services. This has a tendency to create and reinforce the silo working that we are told to disassemble and in a way works against the very essence of integration that we strive towards – after all contracts = £’s, which therefore introduces competition and rivalry into the equation.
The social movement that started in South Devon in 2017, pushed back against the usual way of developing services, refusing to capitulate to the ‘way we do things around here’ mentality and yet still has a governance structure (albeit a loose one), quality assurance frameworks, is building a qualitative and quantitative evidence base and most of all an energy built on passion, a desire to give something back, a drive to improve the lives of others and a drive to maximise our purpose. Dan Pink beautifully illustrates what drives human being to be purpose maximisers here: https://youtu.be/u6XAPnuFjJc . This 11 minute video at the time of writing has had over 17,124,458 views, if you haven’t watched it yet don’t be the one who misses out because grasping the knowledge that Dan Pink shares will ease your journey into orchestrating your own social movement for health and wellbeing.
We built a collaborative partnership between primary, secondary, community and social care; mental and, physical health the voluntary sector and most importantly people with lived-experience. Our work was and is still not formally contractually ‘commissioned’ but was supported in bucket loads by our organisations Chief Executive. We believe that the movement has been possible in part by it’s lack of contractural commissioning. Without contracts we were able to engage with, collaborate and work flexibly and creatively together as an ever growing community of people with a shared purpose, maximising it’s impact across our geography.
Oh and by the way, that hard won budget of £7,500 for 2018 …………. ended being underspent by £5,000. The £2,500 that was spent, mainly went on:
- Funding of community venues (we were very keen to focus this away from the acute hospital as the vast majority of health and wellbeing occurs in the community that a person lives in),
- Training resources for facilitators (the model that we use is each HOPE programme ideally being co-facilitated by two facilitators, a member of the ‘workforce’ and a facilitator with ‘lived-experience’)
- out of pocket expenses for volunteers
- and a very small amount went on volunteer drivers who transported the few in number who were unable to get to the courses on their own.
The first part of this series set the scene for our journey https://changeunlockedtoday.wordpress.com/2019/08/01/passing-a-movement-forward/ , go back and have a quick read, if this is the first of our blogs you have read – it will give you the context. Next time, Chris and I will focus on the different messages that we utilised through trial and much error, when presenting our idea to differing groups of people, including the chucklesome nuances of communicating with some male doctors in senior consultant positions.
Please sign up to follow this blog by entering your email at the bottom of the home page here: https://changeunlockedtoday.wordpress.com/ . Share with us your thoughts about what you have read, in the pages comment box. We want this blog to be interactive and welcome comments and questions from readers as we believe that as a community we can all learn from each other.
In order to be of service to you, we need to understand what you’d like us to describe and share with you to help you make sense of the opportunities that you have in your local system. Interventions are rarely ‘lift and shiftable’ in facsimile form. According the the Health Foundation (2018) https://www.health.org.uk/publications/the-spread-challenge For things to be spreadable and scaled we will need to codify how and what we have done so that you may take the bits that are relevant to you, enabling you to then emulate and improve on our current model, in your local system – by making it your own you can avoid the ‘Not invented around here’ syndrome of non-engagement by stakeholders.
Things take longer than we usually expect, here is a basic outline to give you an idea of how long it has taken to date. The below timeline was created for you on advice from a twitter follower- Thanks, ‘Alison Waters’!
Until next time take care and embrace your inner possibility architect, you won’t know what you are capable until you try.
P.S. Huge thanks to Lyn and Jonathan Ward for the gorgeous photo of Fistral Beach Cornwall.