The Connection Test

We’re pleased to have joined the Coalition for Collaborative Care which is attempting to embed models of collaborative care into the NHS. This blog is based on my recent blog for the C4CC.

Partly driven by the necessity of redefining what public services can do during austerity, a consensus is building that public services are not something that ‘professionals’ do to ‘patients’ or offer to ‘customers’, but are increasingly built on the success with which responsibility, knowledge, resources and – ultimately- power can be shared between people or families with long term support needs and workers who bring expertise, skills and kit, but who can’t magic up long term health and wellbeing for another person.

We’ve joined the C4CC because the need for collaborative care is a strong argument for collaboration between the NHS and the voluntary, community and social enterprise sector, of which we are a part.

Developing collaborative approaches is also a challenge to our sector: does every charity and social enterprise have the kind of close, trusting relationship with individuals and their communities that our sector claims? How do you maintain a strong connection with a community if you are a very large national charity for instance? Some national charities demonstrate that they can combine the clout of being big with the ethos of being localised, but good local relationships can’t be assumed, just because an organisation has a charity number.

It’s also important to understand that whilst collaborative models of care are a strength of charities, community groups and social enterprises, ensuring those models ‘get into the water supply’ (as Canadian social entrepreneur Vickie Cammack puts it) of public services can’t just be the role of our sector. We need a way of building the expectation of collaboration into every contract for every kind of service, whether public, private or not for profit, so that it becomes core business and embedded into all commissioning.

In the absence of a better term so far, I’m calling this expectation, ‘the connection test’ and it’s a test I believe should be universally applied across public service provision and commissioning. The test would be something like this:

Does this intervention or service leave each individual, family or community it is offered to:

  • Better informed (or mired in jargon and bureaucracy)?
  • More confident of their own capacity and more resilient (or more reliant on outside help and expertise)?
  • Better connected to those around them (or with new barriers between them and their family, friends and neighbours)?

It’s easy to see how many charities directly try to achieve these goals, particularly where they are delivering community-based initiatives. Adopting these tests universally would help to drive resources towards such initiatives, because each test is harder to pass, the more institutionalised or industrialised a service becomes.

However, every intervention, and particularly every intervention which is intended to be long term, can pass or fail the test: it can be delivered in a way which is confusing, undermining and isolating, or in a way which shares knowledge, resources and power, which aims to minimise its negative impacts upon relationships and connections and where possible, to support those informal support networks. So, for instance, an intervention may be possible to deliver closer to home, rather than in a distant building, or a team working with an individual can make the choice to share formation and expertise with family carers and to be contactable in an emergency. In some cases, those kinds of choices may make a service cost more, but that cost needs to be set against the costs and benefits of sustaining the individual’s independence or a family’s ability to care.

The ‘customer service’ paradigm for public services is over. Continue reading

Returning it with interest

I was asked to say a few words about empowering communities as part of the National Voices session with NHS England Chief Exec, Simon Stevens, about his Five Year Forward View. I chose to talk about collaboration. (If you’re interested in collaborative health and care, you will be interested in the Coalition for Collaborative Care. The C4CC is working on joined up, personalised, community orientated healthcare and has strong links with Think Local, Act Personal which has been bringing those values to social care for some years now.) Here’s roughly what I said:

The NHS has many challenges – all of them big, many of them complex, some of them truly wicked. Or at least, seen as ‘wicked’, because they don’t respond to the things that services are currently good at. Of those challenges, perhaps the key one is how the health and care system can collaborate with the quarter of our population who have a long term condition, in order that people with long term conditions can live well. We need to achieve that because the NHS can (and does) do many wonderful things, some of them verging on the miraculous, but it can’t ‘fix’ a quarter of the population. And only people themselves can build good lives in good places; that’s something that services can support and enable, but not do for us.

All health and care interventions can be offered collaboratively, not just community-based interventions like Shared Lives, in which someone gets the support and care they need in an ordinary family home, but also acute and hospital-based services.

Collaborative leaders devolve money and power to enable personal tailoring of services, whilst helping those with personal budgets and Personal Health Budgets to work together to co-design new kinds of services. Conversely, commissioners will always fail the collaboration test when they organise services distantly, for large numbers of people. Professionals fail the collaboration test when they see people as customers and even family carers as just another set of clients with needs. Collaborative professionals have the humility to arrange their work around the capabilities and potential of citizens and carers. They share their knowledge, they make things simple and they are keen to accessible in an emergency.

This ability to collaborate with citizens, families and communities is perhaps the key voluntary sector offer to the NHS. But whilst the voluntary sector is far more capable of achieving that collaboration than the statutory sector, it’s important to admit that charities, social enterprises and community groups don’t always succeed in doing so. Many small community groups are embedded in the right relationships with communities, but lack the health and care expertise. Some large national charities have that expertise but have become unmoored from the communities which built them.

So there is a challenge for all sectors: to demonstrate that we have the insight, courage and humility to make hard, uncomfortable changes towards shared purpose, shared resources, shared knowledge and shared ownership. To recognise that we start to collaborate with citizens and their communities not when we deign to engage or consult with them, but when we return to them, with interest, the power, money and knowledge we have all borrowed.